Respiratory syncytial virus upper respiratory tract illnesses in adult blood and marrow transplant recipients: combination therapy with aerosolized ribavirin and intravenous immunoglobulin

Respiratory syncytial virus (RSV) is an important cause of serious respirat ory illness in blood and marrow transplant (BMT) recipients. In some subset s of these immunocompromised patients, RSV upper respiratory illnesses freq uently progress to fatal viral pneumonia, The frequency of progression to p neumonia is higher during the pre-engraftment than during the postengraftme nt period. Once pneumonia develops, the overall mortality is 60-80%, regard less of the treatment strategy. We performed a pilot trial of therapy of RS V upper respiratory illnesses using aerosolized ribavirin and IVIG (500 mg/ kg every other day), with the goal of preventing progression to pneumonia a nd death. Two dosages of ribavirin were used: a conventional regimen (6 g/d ay at 20 mg/ml for 18 h/day) and a high-dose short-duration regimen (6 g/da y at 60 mg/ml for 2 h every 8 h), Fourteen patients were treated for a mean of 13 days (range: 7-23 days). In 10 (71%) patients, the upper respiratory illness resolved. The other four (29%) patients, three of whom were in the pre-engraftment period, developed pneumonia, which was fatal in two. The m ost common adverse effect was psychological distress at being isolated with in a scavenging tent. In conclusion, prompt therapy of RSV upper respirator y illnesses in BMT recipients with a combination of aerosolized ribavirin a nd IVIG was a safe and promising approach to prevent progression to pneumon ia and death.