COMBINATION THERAPY WITH AEROSOLIZED RIBAVIRIN AND INTRAVENOUS IMMUNOGLOBULIN FOR RESPIRATORY SYNCYTIAL VIRUS-DISEASE IN ADULT BONE-MARROW TRANSPLANT RECIPIENTS

Respiratory syncytial virus (RSV) infections in adult BMT recipients a re frequently complicated by fatal pneumonias. Therapy of RSV pneumoni a with aerosolized ribavirin alone has been reported to be associated with a 70% mortality rate. Because immune globulin therapy has been re ported to be beneficial, we conducted a prospective trial of combinati on therapy with aerosolized ribavirin and intravenous immunoglobulin ( IVIG), Aerosolized ribavirin was administered at 20 mg/ml for 18 h a d ay and IVIG was administered at 500 mg/kg every other day for the leng th of ribavirin therapy, Four lots of IVIG were chosen with RSV micron eutralization Ab titers of 1:2048 to 1:8102, Between 8 January and 3 M arch 1993, during a community outbreak, 19 (45%) of 42 hospitalized ad ult BMT recipients with an acute respiratory illness were documented t o have RSV disease, Two-thirds of these infections were hospital-acqui red. All 19 patients presented with signs and symptoms of an upper res piratory tract illness, Sixteen patients developed pneumonia. The mort ality was 22% in nine patients with pneumonia in whom therapy was init iated prior to the onset of profound respiratory failure. In contrast, the mortality was 100% in three patients with pneumonia in whom thera py was initiated within 24 h of respiratory failure requiring mechanic al ventilation and in four untreated patients. We conclude that RSV ma y cause devastating outbreaks of severe pneumonia among hospitalized a dult BMT recipients. Early diagnosis and combination therapy with riba virin and IVIG was associated with a favorable outcome.