title: Corticosteroid use as adjunct therapy for respiratory syncytial virus infection in adult allogeneic stem cell transplant recipients.
abstract: BACKGROUND
  Respiratory syncytial virus (RSV) infection causes significant morbidity and mortality in allogeneic stem cell transplant (allo-SCT) recipients. Although ribavirin and immunoglobulins are common components of therapy, the role of adjunct corticosteroids is not established.
  
  
  OBJECTIVE
  We sought to evaluate corticosteroid utilization in the setting of post-allo-SCT RSV infection in our center and assess post-transplant outcomes including pulmonary function decline.
  
  
  METHODS
  Patients with a history of RSV infection from 2008 to 2014 seen at our institution were identified. Treatment and outcome data were retrospectively collected. Forced expiratory volume at 1 s (FEV1) and carbon monoxide diffusion capacity (DLCO) were collected pre- and post-RSV infection.
  
  
  RESULTS
  During the observation period, RSV was isolated in 53 of 552 patients undergoing allo-SCT (10%) and 45 had evaluable therapy data. RSV-related mortality in this cohort was 4/45 (9%). Twenty-one (47%) were on corticosteroids prior to RSV diagnosis, of whom 11 (24%) had a dose increase post symptom onset. Eight (18%) patients were started on corticosteroids at the time of RSV infection. Corticosteroid therapy at symptom onset was associated with a higher rate of upper respiratory infection (URTI) to lower respiratory infection (LRTI) progression risk ratio (RR) 2.49 (1.21-5.13; P = 0.016), hospital admission RR 2.05 (1.24-3.37; P = 0.005), or intensive care unit admission RR 2.91 (1.89-5.01; P = 0.002). No significant difference was seen with FEV1 and DLCO decline (P = 0.3 and 0.24, respectively) or mortality (P = 0.26).
  
  
  CONCLUSIONS
  Adjunct corticosteroid use in the setting of RSV infection did not improve RSV-related outcomes including long-term pulmonary function. Our results do not support the routine use of corticosteroids; however, this finding does need to be verified in a larger cohort of patients.
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: M
authors.initials: M
authors.lastname: Damlaj
authors.affiliation: Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: G
authors.initials: G
authors.lastname: Bartoo
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: R
authors.initials: R
authors.lastname: Cartin-Ceba
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: D
authors.initials: D
authors.lastname: Gijima
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: H B
authors.initials: HB
authors.lastname: Alkhateeb
authors.affiliation: Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: J
authors.initials: J
authors.lastname: Merten
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: S
authors.initials: S
authors.lastname: Hashmi
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: M
authors.initials: M
authors.lastname: Litzow
authors.affiliation: Division of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: D
authors.initials: D
authors.lastname: Gastineau
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: W
authors.initials: W
authors.lastname: Hogan
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Patnaik
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy*; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D012254:Ribavirin
keywords: allogeneic stem cell transplant; bronchiolitis obliterans; corticosteroids; respiratory syncytial virus