Anaissie Elias J, Mahfouz Tahsine H, Aslan Turan, Pouli Anastasia, Desikan Rahman, Fassas Athanasios, Barlogie Bart
Myeloma Institute for Research and Therapy, The University of Arkansas for Medical Sciences, Little Rock 72205, USA.
Blood. 2004 Mar 1;103(5):1611-7. doi: 10.1182/blood-2003-05-1425. Epub 2003 Oct 2.
Respiratory syncytial virus (RSV) has been reported to cause severe morbidity and mortality among cancer patients receiving chemotherapy with or without autologous peripheral blood stem cell transplantation (APBSCT). However, little is known about the natural history of this infection in these patients, and current standard practice, aerosolized ribavirin plus intravenous immunoglobulin (IVIG), is extremely expensive, difficult to use, and not supported by controlled clinical trials. The purpose of this observational study was to determine the frequency, seasonality, morbidity, and mortality of RSV infection in a group of cancer patients receiving cytotoxic chemotherapy with neither ribavirin nor IVIG treatment. During the period of October 3, 1997, through October 14, 1998, 190 cancer patients (median age, 58 years; 71 women) underwent viral nasopharyngeal washing prior to chemotherapy. Multiple myeloma (MM) accounted for most patients (147, 77%). RSV was recovered from cultures taken from 71 patients (37%) throughout the year, although more frequently during fall and winter seasons (P <.001) than spring and summer. Serious respiratory complications developed in 19 (27%) of 71 RSV-positive patients versus 24 (20%) of 119 patients whose RSV cultures were negative (P =.384). The presence of renal failure or increased lactate dehydrogenase (LDH) prior to chemotherapy and the development of mucositis were the only predictive factors for severe respiratory complications. Recovery of RSV from nasopharyngeal washings among cancer patients is common, occurs throughout the year, and does not appear to increase serious morbidity or mortality. RSV infection may not necessarily be a contraindication for APBSCT or an indication for therapy with aerosolized ribavirin and IVIG.
据报道，呼吸道合胞病毒（RSV）可导致接受化疗的癌症患者（无论是否接受自体外周血干细胞移植[APBSCT]）出现严重发病和死亡情况。然而，对于这些患者中这种感染的自然病史知之甚少，而且目前的标准治疗方法——雾化利巴韦林加静脉注射免疫球蛋白（IVIG）——极其昂贵、使用困难，且未得到对照临床试验的支持。这项观察性研究的目的是确定一组接受细胞毒性化疗且未接受利巴韦林或IVIG治疗的癌症患者中RSV感染的频率、季节性、发病率和死亡率。在1997年10月3日至1998年10月14日期间，190名癌症患者（中位年龄58岁；71名女性）在化疗前进行了病毒性鼻咽冲洗。多发性骨髓瘤（MM）患者占大多数（147名，77%）。全年从71名患者（37%）的培养物中分离出RSV，不过在秋冬季节（P<.001）比春夏季节更频繁。71名RSV阳性患者中有19名（27%）出现严重呼吸并发症，而119名RSV培养阴性的患者中有24名（20%）出现严重呼吸并发症（P =.384）。化疗前存在肾衰竭或乳酸脱氢酶（LDH）升高以及发生粘膜炎是严重呼吸并发症的唯一预测因素。癌症患者鼻咽冲洗液中分离出RSV很常见，全年都有发生，且似乎不会增加严重发病率或死亡率。RSV感染不一定是APBSCT的禁忌症，也不一定是雾化利巴韦林和IVIG治疗的适应症。
