Patients with multiple myeloma may safely undergo autologous transplantation despite ongoing RSV infection and no ribavirin therapy

Respiratory syncytial virus (RSV) has been reported as a cause of death amo ng autologous peripheral blood stem cell (ASCT) and marrow recipients and r ecommendations for therapy with aerosolized ribavirin plus intravenous immu noglobulin (IVIG) made. This therapy is expensive, may be toxic, and causes a significant disruption of patient care. The purpose of this study was to evaluate the morbidity and mortality of RSV infections in patients with mu ltiple myeloma undergoing ASCT without ribavirin therapy. During the months of February-April 1997, 10 consecutive patients (median age 57 years, seve n males) with advanced and heavily pretreated myeloma underwent ASCT while having active RSV upper respiratory tract infection, After melphalan (200 m g/m(2)), all patients became neutropenic (<1000 cells/mm(3)) for a median o f 7 days, Ribavirin was not given to any patient. No patient developed lon; er respiratory tract infection, required transfer to intensive care or died at a median follow-up of 8 months. One patient developed tracheobronchitis requiring oxygenation by nasal cannula, No delay in the treatment of the u nderlying myeloma was incurred, RSV infection may not necessarily be a cont raindication for ASCT or an indication for therapy with aerosolized ribavir in. Additional studies are needed to confirm our preliminary findings.