Respiratory Syncytial Virus in Hematopoietic Cell Transplant Recipients: Factors Determining Progression to Lower Respiratory Tract Disease

Kim, Yae Jean; Guthrie, Katherine A.; Waghmare, Alpana; Walsh, Edward E.; Falsey, Ann R.; Kuypers, Jane; Cent, Anne; Englund, Janet A.; Boeckh, Michael

doi:10.1093/infdis/jit832

Cited by 131 publications

(126 citation statements)

References 45 publications

(56 reference statements)

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“…Most importantly, further validation of the ISI-RSV in another large but different cohort is necessary and for different respiratory viruses as well and should examine other risk factors such as smoking history and conditioning regimen with high-dose total body irradiation. 24 Third, concomitant infections may increase the risk of progression to LRTI or RSV-associated mortality. However, no specific pathogen or site of coinfection has been identified as a definitive predictor for these outcomes.…”

Section: Discussionmentioning

confidence: 99%

Immunodeficiency scoring index to predict poor outcomes in hematopoietic cell transplant recipients with RSV infections

Shah

Ghantoji

Ariza-Heredia

et al. 2014

Blood

130

172

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We developed an immunodeficiency scoring index for respiratory syncytial virus (ISI-RSV) infection, based on a cohort of 237 allogeneic hematopoietic cell transplant (allo-HCT) recipients, that can predict the risk of progression to lower respiratory tract infection (LRTI) and RSV-associated mortality. A weighted index was calculated using adjusted hazard ratios for immunodeficiency markers. Based on the ISI-RSV (range, 0-12), patients were stratified into low (0-2), moderate (3-6), and high (7-12) risk groups. A significant trend of increasing incidence of LRTI and RSV-associated mortality was observed as the risk increased from low to moderate to high (P < .001). Patients in the high-risk group had the greatest benefit of ribavirin-based therapy at the upper respiratory tract infection stage and the highest risk for progression to LRTI and death when antiviral therapy was not given (6.5 [95% confidence interval (CI), 1.8-23.6] and 8.1 [95% CI, 1.1-57.6], respectively). The ISI-RSV is designed to stratify allo-HCT recipients with RSV infection into groups according to their risk for progression to LRTI and RSVassociated mortality. Identification of high-risk groups using this index would distinguish patients who would benefit the most from antiviral therapy, mainly with aerosolized ribavirin. The ISI-RSV should be validated in a multiinstitutional study. (Blood. 2014;123(21):3263-3268)

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Section: Discussionmentioning

confidence: 99%

Immunodeficiency scoring index to predict poor outcomes in hematopoietic cell transplant recipients with RSV infections

Shah

Ghantoji

Ariza-Heredia

et al. 2014

Blood

130

172

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“…One study in adults noted that progression of RSV to lower respiratory tract disease did not occur in patients with a lymphocyte count greater than 1000 cells/mm 3 at time of onset of upper respiratory tract infection. 51 An absolute lymphocyte count of 100 cells/mm 3 or less at the time of RSV upper tract infection was associated with progression to lower respiratory tract disease. In contrast to lymphopenia, analysis of antibody concentration in these adult HSCT recipients indicated no correlation between preexisting anti-RSV antibody concentration and progression from upper to lower respiratory tract disease.…”

Section: Immunocompromised Childrenmentioning

confidence: 96%

“…In contrast to lymphopenia, analysis of antibody concentration in these adult HSCT recipients indicated no correlation between preexisting anti-RSV antibody concentration and progression from upper to lower respiratory tract disease. 51 A retrospective report from 1 institution described 58 immunocompromised children with RSV infection between 1997 and 2005. 52 Sixty-five percent of the RSV-infected children were managed as outpatients.…”

Section: Immunocompromised Childrenmentioning

confidence: 99%

Updated Guidance for Palivizumab Prophylaxis Among Infants and Young Children at Increased Risk of Hospitalization for Respiratory Syncytial Virus Infection

Brady¹,

Byington²,

Davies³

et al. 2014

Pediatrics

317

170

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Guidance from the American Academy of Pediatrics (AAP) for the use of palivizumab prophylaxis against respiratory syncytial virus (RSV) was first published in a policy statement in 1998. Guidance initially was based on the result from a single randomized, placebo-controlled clinical trial conducted in 1996–1997 describing an overall reduction in RSV hospitalization rate from 10.6% among placebo recipients to 4.8% among children who received prophylaxis. The results of a second randomized, placebo-controlled trial of children with hemodynamically significant heart disease were published in 2003 and revealed a reduction in RSV hospitalization rate from 9.7% in control subjects to 5.3% among prophylaxis recipients. Because no additional controlled trials regarding efficacy were published, AAP guidance has been updated periodically to reflect the most recent literature regarding children at greatest risk of severe disease. Since the last update in 2012, new data have become available regarding the seasonality of RSV circulation, palivizumab pharmacokinetics, the changing incidence of bronchiolitis hospitalizations, the effects of gestational age and other risk factors on RSV hospitalization rates, the mortality of children hospitalized with RSV infection, and the effect of prophylaxis on wheezing and palivizumab-resistant RSV isolates. These data enable further refinement of AAP guidance to most clearly focus on those children at greatest risk.

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“…[5][6][7][8][9] Optimal therapy for immunocompromised patients with RSV infection has not been defined and data on treatment are limited. Inhaled ribavirin (Virazole ® ) is US Food and Drug Administration (FDA) approved only for use in RSV-infected hospitalized infants and young children.…”

Section: Statesmentioning

confidence: 99%

“…In one study of HSCT patients, serum neutralizing antibody levels were not significantly different in those who progressed from URTI to LRTI compared to non-progressors. 6 In contrast, in a study of 56 RSV-infected HSCT recipients, of whom 71% Such mutants have been produced in vitro and have been found in 5%-9% of children with RSV breakthrough episodes while receiving palivizumab prophylaxis. 25,26 Although not a significant clinical problem in immunocompetent children, resistant viruses might be more likely to develop because of prolonged shedding and higher levels of virus in immunosuppressed children.…”

mentioning

confidence: 98%

Compassionate use experience with high‐titer respiratory syncytical virus (RSV) immunoglobulin in RSV‐infected immunocompromised persons

Falsey

Koval

DeVincenzo

et al. 2017

Transplant Infectious Dis

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Respiratory Syncytial Virus in Hematopoietic Cell Transplant Recipients: Factors Determining Progression to Lower Respiratory Tract Disease

Cited by 131 publications

References 45 publications

Immunodeficiency scoring index to predict poor outcomes in hematopoietic cell transplant recipients with RSV infections

Immunodeficiency scoring index to predict poor outcomes in hematopoietic cell transplant recipients with RSV infections

Updated Guidance for Palivizumab Prophylaxis Among Infants and Young Children at Increased Risk of Hospitalization for Respiratory Syncytial Virus Infection

Compassionate use experience with high‐titer respiratory syncytical virus (RSV) immunoglobulin in RSV‐infected immunocompromised persons

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