Respiratory syncytial virus infection in recipients of allogeneic stem-cell transplantation: a retrospective study of the incidence, clinical features, and outcome.

BACKGROUND: Respiratory syncytial virus (RSV) is a common cause of serious respiratory infections in hematopoietic stem-cell transplant (HSCT) recipients. We aimed to determine the frequency, risk factors, and outcome of RSV infection in allo-HSCT recipients.

DESIGN AND METHODS: Data were collected from 275 allo-HSCT recipients and identified 32 patients (11.6%, 26 adults and 6 children) RSV infection. A control group was selected matched for age, conditioning intensity and regimens, year of transplant.

RESULTS: Eighteen patients had upper and 14 had lower respiratory tract infection (LRTI). The duration of viral shedding was long (20 days; 7-84). Twenty-eight patients received ribavirin (6 received intravenously, 11 orally, 9 both, 1 oral +aerosolized, and 1 received all three forms). The median duration of therapy was 22.5 days (7-54 days). Three (1.1% of entire cohort, 9.4% of infected patients; 21.4% of patients with LRTI) patients died from the RSV (attributable mortality), whereas two patients died from other subsequent infections 38 days to 5 months after diagnosis of RSV. Seven patients died from progression of underlying disease. Long-term respiratory function was assessed in 14 patients. Two patients died from respiratory failure. Three of 14 patients developed marked respiratory dysfunction after SCT. Three of 16 patients in the RSV group had normal respiratory function compared with 18 of 26 in the control group (P<0.01).

CONCLUSION: RSV infection results in a low overall attributable mortality after allo-HSCT, but progression of the infection to LRTI is associated with increased risk for death. Late respiratory dysfunction is more common among patients, experienced RSV infection compared with controls.