Respiratory Syncytial Virus Immune Globulin Treatment of Lower Respiratory Tract Infection in Pediatric Patients Undergoing Bone Marrow Transplantation - A Compassionate Use Experience

Bone Marrow Transplant. 2000 Jan;25(2):161-5. doi: 10.1038/sj.bmt.1702118.

Abstract

Respiratory syncytial virus (RSV) pneumonia in BMT recipients carries a mortality rate of approximately 50-70% despite ribavirin (Virazole) treatment. In both immunocompetent and immunocompromised animal models, RSV neutralizing antibodies rapidly reduce pulmonary virus load after a single dose. RSV-IGIV (RespiGam) is an IgG immune globulin with high concentrations of RSV neutralizing antibody (>19 200 MU/ml). From June 1991 to February 1996, a compassionate-use protocol using RSV-IGIV for treatment of RSV infections was conducted. Eleven children at multiple centers, mean age 3.3 years (4 months to 9 years), were undergoing BMT and met the protocol criteria. They received a single 1500 mg/kg dose of RSV-IGIV infused over 12 h at a median of 5 days (1-37 days) after RSV symptom onset. Ten of these patients received prior or concurrent aerosolized ribavirin. Serum RSV neutralizing titers were measured in five patients and showed a 3- to 30-fold increase 24 h after RSV-IGIV infusion. Adverse events were mild. One of 11 (9.1%) patients died from their RSV illness (91% RSV survival). In comparison to previously published reports, RSV-IGIV treatment of RSV pneumonia in BMT patients may increase survival above that in such patients treated with ribavirin alone. Bone Marrow Transplantation (2000) 25, 161-165.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Administration, Inhalation
  • Adult
  • Antibodies, Viral / blood
  • Antiviral Agents / administration & dosage
  • Antiviral Agents / therapeutic use
  • Bone Marrow Transplantation / adverse effects*
  • Bone Marrow Transplantation / immunology
  • Child
  • Child, Preschool
  • Clinical Protocols
  • Combined Modality Therapy
  • Humans
  • Immunoglobulins, Intravenous / administration & dosage
  • Immunoglobulins, Intravenous / adverse effects
  • Immunoglobulins, Intravenous / immunology
  • Immunoglobulins, Intravenous / therapeutic use*
  • Immunosuppression / adverse effects
  • Infant
  • Neutralization Tests
  • Pneumonia, Viral / immunology
  • Pneumonia, Viral / therapy*
  • Respiratory Syncytial Virus Infections / immunology
  • Respiratory Syncytial Virus Infections / therapy*
  • Respiratory Syncytial Viruses / immunology*
  • Respiratory Syncytial Viruses / physiology
  • Ribavirin / administration & dosage
  • Ribavirin / therapeutic use
  • Survival Rate
  • Viral Load

Substances

  • Antibodies, Viral
  • Antiviral Agents
  • Immunoglobulins, Intravenous
  • respiratory syncytial virus immune globulin intravenous
  • Ribavirin