title: Impact of aerosolized ribavirin on mortality in 280 allogeneic haematopoietic stem cell transplant recipients with respiratory syncytial virus infections.
abstract: OBJECTIVE
  Respiratory syncytial virus (RSV) infections are well recognized as a significant cause of morbidity and mortality in allogeneic haematopoietic stem cell transplant (allo-HSCT) recipients. We evaluated the spectrum of clinical manifestations, management (including ribavirin-based antiviral therapy) and outcomes of RSV infections and determined the risk factors associated with RSV lower respiratory tract infection (LRTI) and all-cause mortality.
  
  
  METHODS
  In this retrospective study, we analysed clinical data from all laboratory-confirmed RSV infections in allo-HSCT recipients (n = 280) who presented at our institution from January 1996 to May 2009.
  
  
  RESULTS
  Of the 280 patients, 80 (29%) developed LRTI within 20 days (median 1 day, range 0-19 days) and 44 (16%) died within 90 days (median 26 days, range 1-82 days) from RSV diagnosis. Multivariable logistic regression analyses identified several significant risk factors associated with RSV LRTI and all-cause mortality, including age, male sex, neutropenia, lymphocytopenia and lack of ribavirin-based antiviral therapy at the upper respiratory tract infection (URTI) stage. Aerosolized ribavirin-based therapy at the URTI stage was the single most significant factor in reducing the risk of RSV LRTI (83%), all-cause mortality (57%) and RSV-associated mortality (87%) in these patients (P < 0.05), irrespective of the year of RSV diagnosis.
  
  
  CONCLUSIONS
  Our results demonstrate that RSV infections are a significant cause of morbidity and mortality in high-risk allo-HSCT recipients and ribavirin-based antiviral therapy at the URTI stage had a positive impact on both outcomes in this vulnerable population with multiple risk factors.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Dimpy P
authors.initials: DP
authors.lastname: Shah
authors.forename: Shashank S
authors.initials: SS
authors.lastname: Ghantoji
authors.forename: Jharna N
authors.initials: JN
authors.lastname: Shah
authors.forename: Katia K
authors.initials: KK
authors.lastname: El Taoum
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rondon
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Tarrand
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: Roy F
authors.initials: RF
authors.lastname: Chemaly
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000336:Aerosols / Q000008:administration & dosage*; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy* / Q000401:mortality*; D012254:Ribavirin / Q000008:administration & dosage*; D033581:Stem Cell Transplantation / Q000009:adverse effects; D016019:Survival Analysis; D013781:Texas; D014180:Transplantation; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000336:Aerosols; D000998:Antiviral Agents; D012254:Ribavirin
keywords: RSV; immunocompromised; pneumonia; stem cell transplantation