Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Viral Infections

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

Bone Marrow Transplantation volume 25, pages 751–755 (2000)Cite this article

Abstract

Respiratory syncytial virus (RSV) is an important cause of serious respiratory illness in blood and marrow transplant (BMT) recipients. In some subsets of these immunocompromised patients, RSV upper respiratory illnesses frequently progress to fatal viral pneumonia. The frequency of progression to pneumonia is higher during the pre-engraftment than during the post-engraftment period. Once pneumonia develops, the overall mortality is 60–80%, regardless of the treatment strategy. We performed a pilot trial of therapy of RSV upper respiratory illnesses using aerosolized ribavirin and IVIG (500 mg/kg every other day), with the goal of preventing progression to pneumonia and death. Two dosages of ribavirin were used: a conventional regimen (6 g/day at 20 mg/ml for 18 h/day) and a high-dose short-duration regimen (6 g/day 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 most common adverse effect was psychological distress at being isolated within a scavenging tent. In conclusion, prompt therapy of RSV upper respiratory illnesses in BMT recipients with a combination of aerosolized ribavirin and IVIG was a safe and promising approach to prevent progression to pneumonia and death. Bone Marrow Transplantation (2000) 25, 751–755.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Englund JA, Sullivan CJ, Jordan C et al. Respiratory syncytial virus infections in immunocompromised adults Ann Intern Med 1988 109: 203–208

    Article  CAS  Google Scholar 

  2. Martin MA, Bock MJ, Pfaller MA, Wenzel RP . Respiratory syncytial virus infections in adult bone marrow transplant recipients Lancet 1988 1: 1396–1397

    Article  CAS  Google Scholar 

  3. Hertz MI, Englund JA, Snover D et al. Respiratory syncytial virus-induced acute lung injury in adult patients with bone marrow transplants: a clinical approach and review of the literature Medicine 1989 68: 269–281

    Article  CAS  Google Scholar 

  4. Fouillard L, Mouthon L, Laporte JP et al. Severe respiratory syncytial virus pneumonia after autologous bone marrow transplantation: a report of three cases and review Bone Marrow Transplant 1992 9: 97–100

    CAS  PubMed  Google Scholar 

  5. Harrington RD, Hooton TM, Hackman RC et al. An outbreak of respiratory syncytial virus in a bone marrow transplant center J Infect Dis 1992 165: 987–993

    Article  CAS  Google Scholar 

  6. Whimbey E, Champlin RE, Englund JA et al. Combination therapy with aerosolized ribavirin and intravenous immunoglobulin for respiratory syncytial virus disease in adult bone marrow transplant recipients Bone Marrow Transplant 1995 16: 393–399

    CAS  PubMed  Google Scholar 

  7. Whimbey E, Champlin RE, Couch RB et al. Community respiratory virus infections among hospitalized adult bone marrow transplant recipients Clin Infect Dis 1996 22: 778–782

    Article  CAS  Google Scholar 

  8. Whimbey E, Englund JA, Couch RB . Community respiratory virus infections in immunocompromised patients with cancer Am J Med 1997 102: 10–18

    Article  CAS  Google Scholar 

  9. Bowden RA . Respiratory Virus Infections after Marrow Transplant: The Fred Hutchinson Cancer Research Center Experience Am J Med 1997 102: 27–30

    Article  CAS  Google Scholar 

  10. Ljungman P . Respiratory virus infections in bone marrow transplant recipients: the European perspective Am J Med 1997 102: 44–47

    Article  CAS  Google Scholar 

  11. Sparrelid E, Ljungman P, Ekelof-Andstrom E et al. Ribavirin therapy in bone marrow transplant recipients with viral respiratory tract infections Bone Marrow Transplant 1997 19: 905–908

    Article  CAS  Google Scholar 

  12. Hall CB, McBride JT, Walsh EE et al. Aerosolized ribavirin treatment of infants with respiratory syncytial virus infection New Engl J Med 1983 308: 1443–1447

    Article  CAS  Google Scholar 

  13. Liss HP, Bernstein J . Ribavirin aerosol in the elderly Chest 1988 93: 1239–1241

    Article  CAS  Google Scholar 

  14. Englund JA, Piedra PA, Ahn Y et al. High-dose, short-duration ribavirin aerosol therapy compared with standard ribavirin therapy in children with suspected respiratory syncytial virus infection J Pediatr 1994 125: 635–641

    Article  CAS  Google Scholar 

  15. Ogilvie MM, Vathenen AS, Radford M et al. Maternal antibody and respiratory syncytial virus infection in infancy J Med Virol 1981 7: 263–271

    Article  CAS  Google Scholar 

  16. Prince GA, Hemming VG, Horswood RL, Chanock RM . Immunoprophylaxis and immunotherapy of respiratory syncytial virus infection in the cotton rat Virus Res 1985 3: 193–206

    Article  CAS  Google Scholar 

  17. Hemming VG, Prince GA, Horswood RL et al. Studies of passive immunotherapy for infections of respiratory syncytial virus in the respiratory tract of a primate model J Infect Dis 1985 152: 1083–1087

    Article  CAS  Google Scholar 

  18. Hemming VG, Rodriguez W, Kim HW et al. Intravenous immunoglobulin treatment of respiratory syncytial virus infections in infants and young children Antimicrobial Agents Chemother 1987 31: 1882–1886

    Article  CAS  Google Scholar 

  19. Hemming VG, Prince GA, Rodriguez W et al. Respiratory syncytial virus infections and intravenous gamma-globulins Pediatr Infect Dis J 1988 7: S103–S106

    Article  CAS  Google Scholar 

  20. Hemming VG, Prince GA . Passive immunization for the protection of infants and young children from respiratory infection by respiratory syncytial virus. In: Imbach P (ed) Immunotherapy with Intravenous Immunoglobulins Academic Press: New York 1991 pp 103–112

    Chapter  Google Scholar 

  21. Groothuis JR, Levin MJ, Rodriguez W et al. Use of intravenous gamma globulin to passively immunize high-risk children against respiratory syncytial virus: safety and pharmacokinetics Antimicrob Agents Chemother 1991 35: 1469–1473

    Article  CAS  Google Scholar 

  22. Siber GR, Leszcynski J, Pena-Cruz V et al. Protective activity of a human respiratory syncytial virus immune globulin prepared from donors screened by microneutralization assay J Infect Dis 1992 165: 456–463

    Article  CAS  Google Scholar 

  23. Siber GR, Snydman DR . Use of immune globulins in the prevention and treatment of infections. In: Remington JS, Swartz MN (eds) Current Clinical Topics in Infectious Diseases Blackwell Scientific Publications: Boston 1992 pp 208–256

    Google Scholar 

  24. Siber GR, Leombruno D, Leszcynski J et al. Comparison of antibody concentrations and protective activity of respiratory syncytial virus immune globulin and conventional immune globulin J Infect Dis 1993 169: 1368–1373

    Article  Google Scholar 

  25. Graham BS, Davis TH, Tang YW, Gruber WC . Immunoprophylaxis and immunotherapy of respiratory syncytial virus infected mice with respiratory syncytial virus specific immune serum Pediatr Res 1993 34: 167–172

    Article  CAS  Google Scholar 

  26. Meissner HC . Fulton DR, Groothuis JR et al. Controlled trial to evaluate protection of high-risk infants against respiratory syncytial virus disease by using standard intravenous immune globulin Antimicrob Agents Chemother 1993 37: 1655–1658

    Article  CAS  Google Scholar 

  27. Groothuis JR, Simoes EAF, Levin MJ et al. Prophylactic administration of respiratory syncytial virus immune globulin to high-risk infants and young children New Engl J Med 1993 329: 1524–1530

    Article  CAS  Google Scholar 

  28. Groothuis JR, Simoes EAF, Hemming VG et al. Respiratory syncytial virus (RSV) infection in preterm infants and the protective effects of RSV immune globulin (RSVIG) Pediatrics 1995 95: 463–467

    CAS  PubMed  Google Scholar 

  29. De Vincenzo JP, Leombruno D, Soiffer RJ, Siber GR . Immunotherapy of respiratory syncytial virus pneumonia following bone marrow transplantation Bone Marrow Transplant 1996 17: 1051–1056

    CAS  PubMed  Google Scholar 

  30. Rodriquez WJ, Gruber WC, Welliver RC et al. Respiratory syncytial virus (RSV) immune globulin intravenous therapy for RSV lower respiratory tract infection in infants and young children at high risk for severe RSV infections Pediatrics 1997 99: 454–461

    Article  Google Scholar 

  31. The Prevent Study Group . Reduction of respiratory syncytial virus hospitalization among premature infants and infants with bronchopulmonary dysplasia using respiratory syncytial virus immune globulin prophylaxis Pediatrics 1997 99: 93–99

    Article  Google Scholar 

  32. American Academy of Pediatrics . Prevention of respiratory syncytial virus infections: indications for the use of Palivizumab and update on the use of RSV-IGIV Pediatrics 1998 102: 1211–1216

    Article  Google Scholar 

  33. The Impact-RSV study group . Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants Pediatrics 1998 102: 531–537

    Article  Google Scholar 

  34. McColl MD, Corser RB, Bremner J, Chopra R . Respiratory syncytial virus infection in adult BMT recipients: effective therapy with short duration nebulised ribavirin Bone Marrow Transplant 1998 21: 423–425

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Specialties, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    S Ghosh, K Rolston, I Raad, K Jacobson, S Mallik & E Whimbey

  2. Department of Blood and Marrow Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    RE Champlin, SA Giralt, J Neumann & C Ippoliti

  3. Department of Microbiology and Immunology, The Baylor College of Medicine, Houston, TX, USA

    J Englund

Authors
  1. S Ghosh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. RE Champlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J Englund
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. SA Giralt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K Rolston
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. I Raad
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K Jacobson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J Neumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C Ippoliti
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S Mallik
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. E Whimbey
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ghosh, S., Champlin, R., Englund, J. et al. Respiratory syncytial virus upper respiratory tract illnesses in adult blood and marrow transplant recipients: combination therapy with aerosolized ribavirin and intravenous immunoglobulin. Bone Marrow Transplant 25, 751–755 (2000). https://doi.org/10.1038/sj.bmt.1702228

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1702228

Keywords

This article is cited by

Search

Advanced search

Quick links