Department of Clinical Haematology, Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Headington, Oxford OX3 7LE, UK; NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.
Department of Clinical Haematology, Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Headington, Oxford OX3 7LE, UK.
J Infect. 2019 Jun;78(6):461-467. doi: 10.1016/j.jinf.2019.04.004. Epub 2019 Apr 6.
Due to paucity of evidence to guide management of allogeneic haematopoietic stem cell transplantation (allo-HSCT) patients with respiratory syncytial virus (RSV) infections national and international guidelines make disparate recommendations.
The outcomes of allo-HSCT recipients with RSV infection between 2015 and 2017 were assessed using the following treatment stratification; upper respiratory tract infections (URTI) being actively monitored and lower respiratory tract infections (LRTI) treated with short courses of oral ribavirin combined with intravenous immunoglobulin (IVIG, 2 g/kg).
During the study period 49 RSV episodes were diagnosed (47% URTI and 53% LRTI). All patients with URTI recovered without pharmacological intervention. Progression from URTI to LRTI occurred in 15%. Treatment with oral ribavirin given until significant symptomatic improvement (median 7 days [3-12]) and IVIG for LRTI was generally well tolerated. RSV-attributable mortality was low (2%).
In this cohort study, we demonstrate that active monitoring of allo-HSCT patients with RSV in the absence of LRTI was only associated with progression to LRTI in 15% of our patients and therefore appears to be a safe approach. Short course oral ribavirin in combination with IVIG was effective and well-tolerated for LRTI making it a practical alternative to aerosolised ribavirin. This approach was beneficial in reducing hospitalisation, saving nursing times and by using oral as opposed to nebulised ribavirin.
由于缺乏证据来指导患有呼吸道合胞病毒（RSV）感染的异基因造血干细胞移植（allo-HSCT）患者的管理，国家和国际指南提出了不同的建议。
采用以下治疗分层方法评估 2015 年至 2017 年 allo-HSCT 受者 RSV 感染的结局；上呼吸道感染（URTI）进行积极监测，下呼吸道感染（LRTI）采用短疗程口服利巴韦林联合静脉免疫球蛋白（IVIG，2 g/kg）治疗。
在研究期间诊断出 49 例 RSV 感染（47% URTI 和 53% LRTI）。所有 URTI 患者均未接受药物干预而康复。URTI 进展为 LRTI 的发生率为 15%。口服利巴韦林治疗直至症状明显改善（中位数 7 天[3-12 天]），IVIG 用于 LRTI 通常耐受性良好。RSV 相关死亡率低（2%）。
在这项队列研究中，我们证明在不存在 LRTI 的情况下，对 allo-HSCT 患者 RSV 进行积极监测仅与我们患者中 15%的 LRTI 进展相关，因此似乎是一种安全的方法。对于 LRTI，短疗程口服利巴韦林联合 IVIG 有效且耐受性良好，是雾化利巴韦林的一种实用替代方法。这种方法通过使用口服而非雾化利巴韦林，有助于减少住院治疗、节省护理时间。
