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Ferrata Storti Foundation
Haematologica 2019 Volume 104(7):1322-1331
Respiratory syncytial virus in hematopoietic cell transplant recipients and patients with hematologic malignancies
Fareed Khawaja and Roy F. Chemaly
Department of Infectious Diseases, Infection Control and Employee Health, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
ABSTRACT
In the USA and other western nations, respiratory syncytial virus is one of the most commonly encountered respiratory viruses among patients who have been diagnosed with a hematologic malignancy or who have under- gone a stem cell transplant. Multiple studies have been performed to evalu- ate the complications associated with respiratory syncytial virus infections. Other studies have evaluated therapeutic agents and strategies in which these agents can be used. There have also been numerous reports of out- breaks in bone marrow transplant units and oncology wards, where infec- tion control measures have been invaluable in controlling the spread of dis- ease. However, despite these novel approaches, respiratory syncytial virus continues to be potentially fatal in immunocompromised populations. In this review, we discuss the incidence of respiratory syncytial viral infections, risk factors associated with progression from upper respiratory tract infec- tion to lower respiratory tract infection, other complications and outcomes (including mortality), management strategies, and prevention strategies in patients with a hematologic malignancy and in hematopoietic cell transplant recipients.
Introduction
Community respiratory viruses are a common cause of respiratory infections.1-3 These viruses are perhaps best known for their seasonal variation. The outcomes of these infections vary on the basis of the patient population, with adverse out- comes having been described in hematopoietic cell transplant (HCT) recipients and patients with a hematologic malignancy (HM).4-9 One of the most common com- munity respiratory viruses that may lead to the death of HCT recipients and HM patients is respiratory syncytial virus (RSV),4-10 whose incidence is second only to that of influenza according to prior reports;4,5,8,11,12 other viruses include parainfluen- za virus, metapneumovirus, adenovirus, rhinovirus, and bocavirus.
Different strategies have been used for the management of RSV infections in immunocompromised patients, and HCT recipients in particular, including rib- avirin in its different formulations, intravenous immunoglobulins (IVIG), RSV immunoglobulins, and RSV monoclonal antibodies.6 In addition, effective measures have been used to curtail outbreaks of RSV infection in numerous bone marrow transplantation units and oncology wards, with some success;13-19 however, despite some advances over the past two decades in early detection and management of RSV infections in immunocompromised patients, the outcomes related to these infections remain poor.
In this review, we summarize the published data on RSV infections in adult HCT recipients and HM patients, focusing on recent findings. We highlight the incidence of RSV infections, risk factors associated with progression from upper respiratory tract infection (URTI) to lower respiratory tract infection (LRTI), other complica- tions and outcomes (including mortality), management strategies including new agents under investigation, and prevention strategies.
Incidence of respiratory syncytial virus Infection
RSV has been considered a major cause of respiratory viral infection in HM and HCT patients since the 1980s. In the USA alone, RSV accounts for approximately
Correspondence:
ROY F. CHEMALY
rfchemaly@mdanderson.org
Received: January 15, 2019. Accepted: June 6, 2019. Pre-published: June 20, 2019.
doi:10.3324/haematol.2018.215152
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/104/7/1322
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