Ribavirin therapy in bone marrow transplant recipients with viral respiratory tract infections

Abstract

Summary:enza B-virus and parainfluenza virus are less common but can contribute to increased morbidity and mortality. 2-9 A mortality rate of up to 78% has been reported for RSV Treatment with ribavirin was instituted in 12 allogeneic and one autologous bone marrow transplant (BMT) infection and pneumonia in BMT recipients. 10 Ribavirin (1-␤-d-ribofuranosyl-1,2-triazole-3-carboxrecipients with proven respiratory syncytial virus (RSV), influenza B virus or parainfluenza virus infecamide) is a synthetic nucleoside analogue with broad spectrum and in vivo activity against RNA and DNA viruses. 11-tions. RSV was diagnosed in six cases, influenza B virus in four and parainfluenzavirus in three patients. Ribavi- 15 Currently, it is approved only as aerosol therapy in small children with severe RSV pneumonia, 16-17 but it is also rin was given orally or intravenously (15-20 mg/kg/day in three divided doses) and in nine cases with the being used widely in various clinical trials in chronic hepatitis C and HIV infection. Its mechanism of action in RSV addition of ribavirin inhalations (6 g/day). Three patients required ventilator support. Three out of seven infection appears to be interference, at the translatory level, with the expression of viral mRNA and viral proteins. patients with pneumonia, including one patient with RSV who developed pulmonary infiltrates 10 days afterOther possible mechanisms include decrease of intracellular levels of deoxyguanosine triphosphate and thereby inhithe start of therapy, died despite treatment with ribavirin (two RSV, one influenza B). Multiple etiological bition of viral enzymes such as RNA polymerases which has been shown for influenza C 1 virus. 14 There are no agents were found in the fatal cases. The clinical condition improved in 10 of 13 patients during therapy. No reports concerning systemic use of ribavirin in viral respiratory tract infections in BMT patients. serious adverse effects of systemic ribavirin were noticed. Two patients had reversible signs of hemolysis but only one patient required more erythrocyte transMaterials and methods fusions than expected after BMT. Obstructive respiratory distress was often observed (6/9 patients receiving Demography ribavirin inhalation therapy), which resulted in discontinuation of aerosolized therapy in four cases. Time to During the period 1988During the period -1994, treatment with ribavirin was engraftment (WBC Ͻ 0.2 × 10 9 /l) did not differ from instituted in 12 allogeneic and one autologous BMT other non-treated BMT patients. We conclude that ribapatients with proven viral respiratory tract infections. Six virin is well tolerated both orally and intravenously and were children (7 months to 10 years of age) and seven were it may, if instituted before development of hypoxia, adults (20-50 years of age). The indications for BMT were: reduce morbidity and mortality of RSV, influenza B and hematological malignancies (n = 11), malignant osteoparainfluenza in this group of patients. petrosis (n = 1) and Mb. San Filippo A (n = 1). A...

Intravenous ribavirin for respiratory syncytial viral infections in pediatric hematopoietic SCT recipients

“…8 Reported side effects included hemolysis, leukopenia and hyperbilirubinemia. 9,14,16 In our study, no related side effects were observed, which was consistent with previous studies reporting on the use of ribavirin in the hepatitis C infection setting. 17 Recently, Shah et al 6 reviewed and summarized the use of ribavirin from 26 available studies involving adult HSCT patients infected with RSV.…”

“…In this regard, obstructive respiratory distress and dyspnea have been reported in patients receiving ribavirin inhalation therapy, leading to drug discontinuation. 14 14 3 Allogeneic (3) LRTI (3) ivR (1) Combined (2) No No NA 2 (66)…”

“…No RSV-specific gamma globulin or humanized MoAb (palivizumab) was administered. All four LRTI patients showed a favorable clinical response, with 100% survival after a mean follow-up of 17 months (range [13][14][15][16][17][18][19][20][21][22][23][24]. With regard to IVIG, our guideline was not adhered to in two patients with severe LRTI-RSV who did not receive combined therapy with IVIG (episodes 1 and 6).…”

Pre-emptive oral ribavirin therapy of paramyxovirus infections after haematopoietic stem cell transplantation: a pilot study

“…There is only one study reporting the use of oral ribavirin for respiratory virus infections after HSCT. 11 However, the efficacy and required oral dose of ribavirin in HSCT are uncertain.…”

The outcome of 26 patients with respiratory syncytial virus infection following allogeneic stem cell transplantation

“…[13][14][15][16] In one review, 13 RSV was found to be the responsible agent in 49% of cases, with just over half of these affecting the lower respiratory tract. Treatment options are either anti-viral, primarily using the virustatic agent, ribavirin or immunological, with the use of pooled or RSV specific immunoglobulin.…”