Journal Article

Pretransplantation Respiratory Syncytial Virus Infection: Impact of a Strategy to Delay Transplantation

Angela J. Peck, Lawrence Corey and Michael Boeckh

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 39, issue 5, pages 673-680
Published in print September 2004 | ISSN: 1058-4838
Published online September 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/422994
Pretransplantation Respiratory Syncytial Virus Infection: Impact of a Strategy to Delay Transplantation

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Background. Delay of hematopoietic stem cell transplantation (HSCT) has been suggested if upper respiratory tract infection (URTI) due to respiratory syncytial virus (RSV) occurs in transplantation candidates, but the efficacy of this strategy in preventing posttransplantation RSV infection is unknown.

Methods. In a retrospective study, we reviewed charts of patients who underwent transplantation at Fred Hutchinson Cancer Research Center (Seattle, WA) during the period of June 1987 through December 2000 and evaluated the strategy of delaying HSCT in candidates with laboratory-confirmed RSV URTI.

Results. Thirty-one of 37 patients had RSV URTI before conditioning, 2 (6.5%) of whom developed RSV infection after HSCT. In 6 of 37 patients, symptoms of URTI were present during the start of conditioning, but RSV virologic confirmation occurred a median of 4.5 days (range, 2–5 days) into the conditioning regimen. Conditioning was aborted for 3 of 6 patients; none had progression to RSV pneumonia. Of the 3 patients in whom HSCT proceeded as scheduled, 2 developed RSV pneumonia. Overall, RSV pneumonia occurred in 1 of 34 patients for whom HSCT was delayed, compared with 2 of 3 patients for whom there was no delay (P = .01).

Conclusions. In patients with pretransplantation RSV URTI, delay of HSCT was associated with a lower risk of pneumonia than was no delay. Because URTIs can progress to severe complications in patients receiving HSCTs, these results support Centers for Disease Control and Prevention/American Society of Blood and Marrow Transplantation recommendations that HSCT be delayed on the basis of symptoms of URTI rather than waiting for virologic confirmation.

Journal Article.  3817 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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