title: Respiratory syncytial virus infections in children with cancer.
abstract: Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections (LRTIs) in children, especially those with cancer. Data on RSV infections in this vulnerable population is limited. We conducted a retrospective study of all RSV infections in children with cancer from 1998 to 2009 to determine characteristics and outcomes of these infections, identify risk factors for LRTI and mortality, and the effect of antiviral therapy on these outcomes. We identified 59 patients with a median age of 5 years; 53% had hematologic malignancy, 32% were hematopoietic stem cell transplant recipients, 39% had received corticosteroids, and 76% cytotoxic chemotherapy within 1 month before RSV infection. LRTI developed in 22 (37%) patients with a trend of higher rate in males (odds ratio=2.57 [0.86-7.62], P=0.09) and children with lymphocytopenia (odds ratio=2.95 [0.86-10.12], P=0.085). No significant differences were observed in the rates of progression to LRTI (3/10 [30%] vs. 19/49 [39%], P=0.729) and RSV-associated mortality (0/10 [0%] vs. 3/49 [6%], P=0.422) for patients receiving antiviral therapy at upper respiratory tract infection stage compared with those who did not. However, patients with LRTI had significantly better outcomes when treated with aerosolized ribavirin plus immunomodulators (mainly palivizumab) when compared with aerosolized ribavirin alone (mortality rates: 0/6 [0%] vs. 3/4 [75%], P=0.03). Ribavirin did not show any benefit in reducing LRTI or mortality; however, addition of palivizumab to the treatment regimen may be potentially beneficial, especially for children with LRTI.
authors: Departments of *Infectious Diseases, Infection Control, and Employee Health ‡Stem Cell Transplantation and Cellular Therapy §Pediatrics, The University of Texas MD Anderson Cancer Center †Department of Neurology, Baylor College of Medicine, Houston, TX.
authors: Roy F
authors: RF
authors: Chemaly
authors: Shashank S
authors: SS
authors: Ghantoji
authors: Dimpy P
authors: DP
authors: Shah
authors: Jharna N
authors: JN
authors: Shah
authors: Katia K
authors: KK
authors: El Taoum
authors: Richard E
authors: RE
authors: Champlin
authors: Cesar A
authors: CA
authors: Nunez
authors: Victor
authors: V
authors: Mulanovich
authors: Ella
authors: E
authors: Ariza-Heredia
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D000069455:Palivizumab; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy / Q000401:mortality*; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000401:mortality*; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D012254:Ribavirin; D000069455:Palivizumab