Open AccessPS1542 RESPIRATORY SYNCYTIAL VIRUS AND HUMAN METAPNEUMOVIRUS INFECTIONS AFTER ALLOGENEIC STEM CELL TRANSPLANTATION: IMPACT OF THE IMMUNODEFICIENCY SCORING INDEX AND RIBAVIRIN TREATMENT ON THE OUTCOMES
Author(s) -
Akhmedov M.,
Wais V.,
Sala E.,
Neagoie A.,
Gantner A.,
Harsdorf S.,
Kuchenbauer F.,
Schubert A.,
Michael D.,
Döhner H.,
Bunjes D.
Publication year - 2019
Publication title -
hemasphere
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 11
ISSN - 2572-9241
DOI - 10.1097/01.hs9.0000564428.28977.7e
Subject(s) - ribavirin , medicine , human metapneumovirus , lower respiratory tract infection , respiratory tract infections , cohort , transplantation , immunology , respiratory system , virus , hepatitis c virus
Background: Respiratory viral infections are a major cause of morbidity and mortality among allogeneic stem cell transplant recipients. In order to predict outcomes of the respiratory syncytial virus (RSV) infections in HSCT recipients, the immunodeficiency scoring index (ISI) was recently introduced. Aims: We decided to investigate the predictive role of the ISI in regards to progression to lower respiratory tract infection (LRTI) and mortality in an independent cohort of RSV and human metapneumovirus (hMPV) infected allogeneic stem cell transplant recipients. Methods: In total 71 patients were included in this study: 41 patients presented with upper respiratory tract infection (URTI) and 30 had primary LRTI. Patients were stratified as per ISI criteria into low, moderate and high‐risk groups. Patients in the URTI cohort received treatment with either oral ribavirin (n = 20), intravenous ribavirin (n = 1) or with a combination of intravenous ribavirin and intravenous immunoglobulin (n = 1); 19 patients received no antiviral therapy. Patients in the LRTI cohort were treated either with intravenous ribavirin (n = 12), a combination of intravenous ribavirin and intravenous immunoglobulin (n = 16) or with oral ribavirin (n = 2). Results: Progression from URTI to LRTI was observed in 14% of the low‐risk group, 20% of moderate and 75% of the high‐risk group, p = 0,001. The trend of increased progression rate persisted after adjustment to received therapy, p < 0,0001. 21% of RSV‐infected patients further progressed to LRTI compared to 29% of hMPV‐infected patients, p = 0,524. In the LRTI cohort no (0%) virus‐associated mortality was observed in the low‐risk group compared to 16% in moderate and 43% in the high‐risk group, p = 0,160. 17% deaths were observed among patients infected with RSV and 29% with hMPV, p = 0,517. With a median follow‐up of 20 months, the median overall survival was not reached in both low and moderate‐risk groups and was only 6 months in the high‐risk group [95% CI: 0,23–11,77; p = 0,015]. Summary/Conclusion: ISI could predict progression from URTI to LRTI in a mixed cohort of RSV and hMPV infected allogeneic stem cell transplant recipients. The trend persisted after adjustment to received therapy. ISI was not able to predict mortality in the LRTI cohort but could predict overall survival in the entire cohort. No differences were observed in the outcomes of RSV and hMPV infected patients.