Pretransplantation Respiratory Syncytial Virus Infection: Impact of a Strategy to Delay Transplantation

Abstract

In patients with pretransplantation RSV URTI, delay of HSCT was associated with a lower risk of pneumonia than was no delay. Because URTIs can progress to severe complications in patients receiving HSCTs, these results support Centers for Disease Control and Prevention/American Society of Blood and Marrow Transplantation recommendations that HSCT be delayed on the basis of symptoms of URTI rather than waiting for virologic confirmation.

Viral Infections in Patients with Hematological Malignancies

“…Patients who develop respiratory virus infections prior to the initiation of treatment or transplantation, should if possible, have their therapy delayed. 49 RSV and influenza are primarily winter viruses. Parainfluenza virus infections are most prevalent during the summer.…”

“…The risk of death from a respiratory viral pneumonia has ranged from 9% to 82%, and appears to vary little between the different groups of patients with active hematological malignancy. 48,49 Rapid diagnosis is made by viral antigen or nucleic acid detection. An RT-PCR assay that detects RNA from RSV, Influenza A and B, and parainfluenza viruses from nasal wash and nasopharyngeal specimens is highly sensitive and readily available.…”

Influenza virus reactivation after remission with oseltamivir treatment in a patient undergoing nonmyeloablative bone marrow transplantation

“…Hence, patients who develop respiratory virus infections before the initiation of treatment or transplantation should, if possible, have their therapy delayed. [6][7][8] However, in the present patient, NMBMT could not be postponed because the patient had acquired the infection after the conditioning regimen had been started. In addition, he had developed other risks of infection due to prolonged suppression of normal hematopoiesis caused by his highly progressive disease that was resistant to chemotherapy.…”

Respiratory syncytial virus in immunocompromised patients in a paediatric hospital: 5 years’ experience

“…15 In patients receiving an HSCT, delaying chemotherapy has been associated with a lower rate of progression to pneumonia. 16 Future research could investigate how delaying treatment of the underlying disease as a result of RSV infection impacts the overall survival rate of patients. In our cohort, 21% of RSV infections were nosocomial.…”