EFFECTIVE USE OF ORAL RIBAVIRIN FOR RESPIRATORY SYNCYTIAL VIRAL INFECTIONS IN ADULT ALLOGENEIC HAEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS
(Abstract release date: 05/19/16)
EHA Library. Gorcea C. 06/09/16; 133088; E1539
Dr. Claudia Gorcea
Contributions
Contributions
Abstract
Abstract: E1539
Type: Eposter Presentation
Background
Respiratory syncytial virus (RSV) is a common cause of respiratory viral infections and is associated with increased morbidity and mortality in patients undergoing haematopoietic stem cell transplantation (HSCT). Little is known about the best management strategy in this high risk group and there is very little data on oral ribavirin treatment.
Aims
The outcome of adult allogeneic HSCT recipients with RSV infection treated with oral ribavirin was analysed at a single UK centre.
Methods
We performed a retrospective analysis of 23 consecutive RSV cases treated with oral Ribavirin between December 2010 and February 2015. Patient characteristics: male 12, median age 52 years (range 20 to 69). Underlying diagnoses: acute leukaemia 11, myelodysplasia 4, aplastic anaemia 3, multiple myeloma 3, chronic leukaemia 2. Allogeneic HSCT characteristics: 16 reduced intensity conditioning (RIC) and 7 myeloablative conditioning.RSV diagnosis was established by polymerase chain reaction (PCR) assay. At diagnosis, 7 patients presented with lower respiratory tract infection (LRTI) as defined by new infiltrate on chest X-ray (CXR), signs on auscultation or hypoxia, whereas 16 experienced upper RTI.All patients with a positive RSV PCR result received treatment. We initiated oral Ribavirin at a dose of 15mg/kg divided into 3 daily doses with no subsequent dose escalation. The median treatment duration was 10 days (range 5 to 47). Additional therapies were administered concomitantly: 3 patients received immunoglobulin replacement, 17 received antimicrobials and 3 patients also received antifungal treatment for suspected superimposed bacterial or fungal infection.Patients were retrospectively scored using the immunodeficiency scoring index for RSV (ISI-RSV) which takes into consideration neutropenia (<0.5x109/L), lymphopenia (<0.2x109/L), age (≥40 years), myeloablative conditioning regimen, graft versus host disease (GVHD acute/chronic), corticosteroid treatment and pre-engraftment period (or within 30 days of HSCT) to determine the risk of progression to LRTI. In our cohort, 14 patients were low risk with an ISI of 0-2 (2 patients ISI 0, 6 patients ISI 1, 6 patients ISI 2) and 9 patients were moderate risk with an ISI of 3-4 (8 patients ISI 3, 1 patient ISI 4) and therefore oral treatment was felt to have been appropriate, on retrospective analysis.
Results
The treatment was well tolerated with minor side effects in 2 patients. In total, 19 patients completed exclusively oral ribavirin treatment, whereas 4 were escalated to aerosolised ribavirin due to worsening symptoms. Only 7 patients required admission for intravenous antibiotics and/or aerosolised ribavirin. The median admission period was 7 days (range 1 to 16). None of the patients required intensive care admission.After a median follow-up of 17 months (range 4 to 48), 17 patients are alive and 6 died. One patient died of RSV pneumonitis complicated with bacterial and suspected fungal infection on the background of relapsed disease and 5 died of unrelated causes.
Conclusion
RSV in post allogeneic HSCT patients remains a challenge due to the high frequency of infection and increased morbidity and mortality associated with RSV LRTI. Prompt initiation of treatment is essential and may avoid unnecessary hospital admission. Our experience supports the use of oral ribavirin in selected adult HSCT recipients, after a careful risk assessment has been performed. Prospective studies and larger numbers of patients are needed to determine the optimal therapy for this patient group.
Session topic: E-poster
Keyword(s): Transplant
Type: Eposter Presentation
Background
Respiratory syncytial virus (RSV) is a common cause of respiratory viral infections and is associated with increased morbidity and mortality in patients undergoing haematopoietic stem cell transplantation (HSCT). Little is known about the best management strategy in this high risk group and there is very little data on oral ribavirin treatment.
Aims
The outcome of adult allogeneic HSCT recipients with RSV infection treated with oral ribavirin was analysed at a single UK centre.
Methods
We performed a retrospective analysis of 23 consecutive RSV cases treated with oral Ribavirin between December 2010 and February 2015. Patient characteristics: male 12, median age 52 years (range 20 to 69). Underlying diagnoses: acute leukaemia 11, myelodysplasia 4, aplastic anaemia 3, multiple myeloma 3, chronic leukaemia 2. Allogeneic HSCT characteristics: 16 reduced intensity conditioning (RIC) and 7 myeloablative conditioning.RSV diagnosis was established by polymerase chain reaction (PCR) assay. At diagnosis, 7 patients presented with lower respiratory tract infection (LRTI) as defined by new infiltrate on chest X-ray (CXR), signs on auscultation or hypoxia, whereas 16 experienced upper RTI.All patients with a positive RSV PCR result received treatment. We initiated oral Ribavirin at a dose of 15mg/kg divided into 3 daily doses with no subsequent dose escalation. The median treatment duration was 10 days (range 5 to 47). Additional therapies were administered concomitantly: 3 patients received immunoglobulin replacement, 17 received antimicrobials and 3 patients also received antifungal treatment for suspected superimposed bacterial or fungal infection.Patients were retrospectively scored using the immunodeficiency scoring index for RSV (ISI-RSV) which takes into consideration neutropenia (<0.5x109/L), lymphopenia (<0.2x109/L), age (≥40 years), myeloablative conditioning regimen, graft versus host disease (GVHD acute/chronic), corticosteroid treatment and pre-engraftment period (or within 30 days of HSCT) to determine the risk of progression to LRTI. In our cohort, 14 patients were low risk with an ISI of 0-2 (2 patients ISI 0, 6 patients ISI 1, 6 patients ISI 2) and 9 patients were moderate risk with an ISI of 3-4 (8 patients ISI 3, 1 patient ISI 4) and therefore oral treatment was felt to have been appropriate, on retrospective analysis.
Results
The treatment was well tolerated with minor side effects in 2 patients. In total, 19 patients completed exclusively oral ribavirin treatment, whereas 4 were escalated to aerosolised ribavirin due to worsening symptoms. Only 7 patients required admission for intravenous antibiotics and/or aerosolised ribavirin. The median admission period was 7 days (range 1 to 16). None of the patients required intensive care admission.After a median follow-up of 17 months (range 4 to 48), 17 patients are alive and 6 died. One patient died of RSV pneumonitis complicated with bacterial and suspected fungal infection on the background of relapsed disease and 5 died of unrelated causes.
Conclusion
RSV in post allogeneic HSCT patients remains a challenge due to the high frequency of infection and increased morbidity and mortality associated with RSV LRTI. Prompt initiation of treatment is essential and may avoid unnecessary hospital admission. Our experience supports the use of oral ribavirin in selected adult HSCT recipients, after a careful risk assessment has been performed. Prospective studies and larger numbers of patients are needed to determine the optimal therapy for this patient group.
Session topic: E-poster
Keyword(s): Transplant
Abstract: E1539
Type: Eposter Presentation
Background
Respiratory syncytial virus (RSV) is a common cause of respiratory viral infections and is associated with increased morbidity and mortality in patients undergoing haematopoietic stem cell transplantation (HSCT). Little is known about the best management strategy in this high risk group and there is very little data on oral ribavirin treatment.
Aims
The outcome of adult allogeneic HSCT recipients with RSV infection treated with oral ribavirin was analysed at a single UK centre.
Methods
We performed a retrospective analysis of 23 consecutive RSV cases treated with oral Ribavirin between December 2010 and February 2015. Patient characteristics: male 12, median age 52 years (range 20 to 69). Underlying diagnoses: acute leukaemia 11, myelodysplasia 4, aplastic anaemia 3, multiple myeloma 3, chronic leukaemia 2. Allogeneic HSCT characteristics: 16 reduced intensity conditioning (RIC) and 7 myeloablative conditioning.RSV diagnosis was established by polymerase chain reaction (PCR) assay. At diagnosis, 7 patients presented with lower respiratory tract infection (LRTI) as defined by new infiltrate on chest X-ray (CXR), signs on auscultation or hypoxia, whereas 16 experienced upper RTI.All patients with a positive RSV PCR result received treatment. We initiated oral Ribavirin at a dose of 15mg/kg divided into 3 daily doses with no subsequent dose escalation. The median treatment duration was 10 days (range 5 to 47). Additional therapies were administered concomitantly: 3 patients received immunoglobulin replacement, 17 received antimicrobials and 3 patients also received antifungal treatment for suspected superimposed bacterial or fungal infection.Patients were retrospectively scored using the immunodeficiency scoring index for RSV (ISI-RSV) which takes into consideration neutropenia (<0.5x109/L), lymphopenia (<0.2x109/L), age (≥40 years), myeloablative conditioning regimen, graft versus host disease (GVHD acute/chronic), corticosteroid treatment and pre-engraftment period (or within 30 days of HSCT) to determine the risk of progression to LRTI. In our cohort, 14 patients were low risk with an ISI of 0-2 (2 patients ISI 0, 6 patients ISI 1, 6 patients ISI 2) and 9 patients were moderate risk with an ISI of 3-4 (8 patients ISI 3, 1 patient ISI 4) and therefore oral treatment was felt to have been appropriate, on retrospective analysis.
Results
The treatment was well tolerated with minor side effects in 2 patients. In total, 19 patients completed exclusively oral ribavirin treatment, whereas 4 were escalated to aerosolised ribavirin due to worsening symptoms. Only 7 patients required admission for intravenous antibiotics and/or aerosolised ribavirin. The median admission period was 7 days (range 1 to 16). None of the patients required intensive care admission.After a median follow-up of 17 months (range 4 to 48), 17 patients are alive and 6 died. One patient died of RSV pneumonitis complicated with bacterial and suspected fungal infection on the background of relapsed disease and 5 died of unrelated causes.
Conclusion
RSV in post allogeneic HSCT patients remains a challenge due to the high frequency of infection and increased morbidity and mortality associated with RSV LRTI. Prompt initiation of treatment is essential and may avoid unnecessary hospital admission. Our experience supports the use of oral ribavirin in selected adult HSCT recipients, after a careful risk assessment has been performed. Prospective studies and larger numbers of patients are needed to determine the optimal therapy for this patient group.
Session topic: E-poster
Keyword(s): Transplant
Type: Eposter Presentation
Background
Respiratory syncytial virus (RSV) is a common cause of respiratory viral infections and is associated with increased morbidity and mortality in patients undergoing haematopoietic stem cell transplantation (HSCT). Little is known about the best management strategy in this high risk group and there is very little data on oral ribavirin treatment.
Aims
The outcome of adult allogeneic HSCT recipients with RSV infection treated with oral ribavirin was analysed at a single UK centre.
Methods
We performed a retrospective analysis of 23 consecutive RSV cases treated with oral Ribavirin between December 2010 and February 2015. Patient characteristics: male 12, median age 52 years (range 20 to 69). Underlying diagnoses: acute leukaemia 11, myelodysplasia 4, aplastic anaemia 3, multiple myeloma 3, chronic leukaemia 2. Allogeneic HSCT characteristics: 16 reduced intensity conditioning (RIC) and 7 myeloablative conditioning.RSV diagnosis was established by polymerase chain reaction (PCR) assay. At diagnosis, 7 patients presented with lower respiratory tract infection (LRTI) as defined by new infiltrate on chest X-ray (CXR), signs on auscultation or hypoxia, whereas 16 experienced upper RTI.All patients with a positive RSV PCR result received treatment. We initiated oral Ribavirin at a dose of 15mg/kg divided into 3 daily doses with no subsequent dose escalation. The median treatment duration was 10 days (range 5 to 47). Additional therapies were administered concomitantly: 3 patients received immunoglobulin replacement, 17 received antimicrobials and 3 patients also received antifungal treatment for suspected superimposed bacterial or fungal infection.Patients were retrospectively scored using the immunodeficiency scoring index for RSV (ISI-RSV) which takes into consideration neutropenia (<0.5x109/L), lymphopenia (<0.2x109/L), age (≥40 years), myeloablative conditioning regimen, graft versus host disease (GVHD acute/chronic), corticosteroid treatment and pre-engraftment period (or within 30 days of HSCT) to determine the risk of progression to LRTI. In our cohort, 14 patients were low risk with an ISI of 0-2 (2 patients ISI 0, 6 patients ISI 1, 6 patients ISI 2) and 9 patients were moderate risk with an ISI of 3-4 (8 patients ISI 3, 1 patient ISI 4) and therefore oral treatment was felt to have been appropriate, on retrospective analysis.
Results
The treatment was well tolerated with minor side effects in 2 patients. In total, 19 patients completed exclusively oral ribavirin treatment, whereas 4 were escalated to aerosolised ribavirin due to worsening symptoms. Only 7 patients required admission for intravenous antibiotics and/or aerosolised ribavirin. The median admission period was 7 days (range 1 to 16). None of the patients required intensive care admission.After a median follow-up of 17 months (range 4 to 48), 17 patients are alive and 6 died. One patient died of RSV pneumonitis complicated with bacterial and suspected fungal infection on the background of relapsed disease and 5 died of unrelated causes.
Conclusion
RSV in post allogeneic HSCT patients remains a challenge due to the high frequency of infection and increased morbidity and mortality associated with RSV LRTI. Prompt initiation of treatment is essential and may avoid unnecessary hospital admission. Our experience supports the use of oral ribavirin in selected adult HSCT recipients, after a careful risk assessment has been performed. Prospective studies and larger numbers of patients are needed to determine the optimal therapy for this patient group.
Session topic: E-poster
Keyword(s): Transplant
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