title: Effective use of oral ribavirin for respiratory syncytial viral infections in allogeneic haematopoietic stem cell transplant recipients.
abstract: BACKGROUND
  Respiratory syncytial virus (RSV) is a frequent cause of respiratory viral infections, increasing the morbidity and mortality in allogeneic haematopoietic stem cell transplantation (HSCT) recipients. Little is known about the best management strategy in this immunocompromised group and there are very few data on oral ribavirin treatment.
  
  
  OBJECTIVE
  To evaluate the effectiveness of oral ribavirin in allogeneic HSCT patients with RSV infection.
  
  
  METHODS
  Twenty-three RSV cases treated with oral ribavirin were analysed retrospectively. RSV diagnosis was established by polymerase chain reaction assay. Oral ribavirin was initiated at 15 mg/kg/day in three divided doses for 10 days, with no subsequent dose escalation, as per centre policy.
  
  
  RESULTS
  At diagnosis, seven patients presented with lower respiratory tract infection (RTI), whereas 16 had upper RTI. Oral ribavirin was well tolerated with minor adverse effects. The median treatment duration was 10 days (range: 5-47). After a median follow-up of 17 months (range: 4-48), 17 patients are alive. We recorded one RSV-related and five non-related deaths.
  
  
  CONCLUSIONS
  To our knowledge, this is the largest single centre study yet performed on adult allogeneic HSCT recipients with RSV infection treated with oral ribavirin. Prompt initiation of treatment is essential and may avoid hospital admission. Our experience supports the use of oral ribavirin, but large prospective studies are needed to determine the optimal therapy in this patient group.
authors.affiliation: Department of Clinical Haematology, Manchester Royal Infirmary, Central Manchester NHS Foundation Trust, Manchester, UK. Electronic address: Claudia.gorcea@cmft.nhs.uk.
authors.forename: C M
authors.initials: CM
authors.lastname: Gorcea
authors.affiliation: Department of Clinical Haematology, Manchester Royal Infirmary, Central Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: E
authors.initials: E
authors.lastname: Tholouli
authors.affiliation: Department of Virology, Manchester Royal Infirmary, Central Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: A
authors.initials: A
authors.lastname: Turner
authors.affiliation: Department of Clinical Haematology, Manchester Royal Infirmary, Central Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: M
authors.initials: M
authors.lastname: Saif
authors.affiliation: Pharmacy Department, Manchester Royal Infirmary, Central Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: E
authors.initials: E
authors.lastname: Davies
authors.affiliation: Pharmacy Department, Manchester Royal Infirmary, Central Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: E
authors.initials: E
authors.lastname: Battersby
authors.affiliation: Department of Clinical Haematology, Manchester Royal Infirmary, Central Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: F L
authors.initials: FL
authors.lastname: Dignan
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy*; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage*; D016019:Survival Analysis; D066027:Transplant Recipients; D014184:Transplantation, Homologous / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin
keywords: Allogeneic stem cell transplant; Immunocompromised; Respiratory infection; Respiratory syncytial virus; Ribavirin