The outcome of 26 patients with respiratory syncytial virus infection following allogeneic stem cell transplantation

Respiratory syncytial virus (RSV) is known to cause acute lung injury in th e immunocompromised host, especially recipients of bone marrow allografts, Specific prognostic factors for the development of severe life-threatening disease remain to be identified as does the optimum treatment of establishe d disease, Over a S-year period the incidence and outcome of RSV in BMT rec ipients was analysed retrospectively. Prognostic factors assessed included type of transplant, engraftment status at the time of infection, the presen ce of lower respiratory tract disease, viral genotype and treatment receive d. During the study period, 26 of 336 (6.3 %) allogeneic stem-cell recipien ts were identified as having RSV, Five patients (19.2%) died as a direct re sult of RSV, One patient died secondary to an intracranial bleed with conco mitant RSV, There were four patients with graft failure (two primary and tw o secondary) attributable to the presence of RSV, two of whom subsequently died of infections related to prolonged myelosuppression. The presence of l ower respiratory tract infection and a poor overall outcome was the only st atistically significant association. Unrelated donor transplants and AML as the underlying disease appeared to be associated with a poorer outcome. En graftment status, viral genotype and RSV treatment received did not correla te with outcome. We conclude that future studies are required to identify e arly sensitive and reproducible prognostic factors of RSV in the immunocomp romised host, The roles of intravenous and nebulised ribavirin need to be c larified by prospective controlled trials.