Treatment of respiratory syncytial virus infection in adult patients with hematologic malignancies based on an institution‐specific guideline

Abstract

A total of 26 adults with hematologic malignancies and/or hematopoietic stem cell transplant were treated for respiratory syncytial virus (RSV) infection based on an institutional guideline. Thirteen patients received aerosolized ribavirin, and 13 received aerosolized ribavirin and intravenous palivizumab. Two deaths, not attributed to RSV infection, occurred within 90 days of diagnosis.

Respiratory syncytial virus: current and emerging treatment options

“…No adverse events were reported related to palivizumab 17. A survey of current practices among the International Pediatric Lung Transplant Collaborative was published in 2012 18. This survey revealed that of the 15 centers who responded to questions regarding treatment strategies, six centers reported using palivizumab (three IV, three intramuscular).…”

“…This survey revealed that of the 15 centers who responded to questions regarding treatment strategies, six centers reported using palivizumab (three IV, three intramuscular). The dose reported by all centers was 15 mg/kg over the course of one day (intramuscular) or up to three days (IV) 18. In adult populations, some data has also been published with regard to the utility of palivizumab in the setting of acute RSV infection 19.…”

“…Ribavirin inhibits replication of both RNA and DNA viruses, including RSV 25. This inhibition is achieved by direct (interference with RNA capping, polymerase inhibition, lethal mutagenesis) and indirect (inosine monophosphate dehydrogenase inhibition and immunomodulatory effects) mechanisms 18. Ribavirin can be administered intravenously, orally, and by aerosolization.…”

“…RSV treatment strategies for infant lung transplant recipients, including ribavirin and IVIG or corticosteroids, vary at pediatric lung transplant centers18 and are reported to decrease mortality and are well tolerated,17 but comparison studies are not available. In a retrospective study, no significant differences were noted in 6-month outcomes between oral and aerosolized ribavirin therapy for RSV infection after lung transplantation 33.…”

“…Safety and financial concerns often overshadow the potential benefits of ribavirin, limiting its routine clinical use 18,29. Based on the current medical literature, ribavirin is an efficacious treatment for acute RSV infection, especially in patients at risk for mortality related to the acute infection such as infants and younger children and lung transplant recipients.…”