Management of respiratory viral infections in hematopoietic cell transplant recipients and patients with hematologic malignancies

Clin Infect Dis. 2014 Nov 15;59 Suppl 5(Suppl 5):S344-51. doi: 10.1093/cid/ciu623.

Abstract

Despite preventive strategies and increased awareness, a high incidence of respiratory viral infections still occur in patients with hematologic malignancies (HMs) and in recipients of hematopoietic cell transplant (HCT). Progression of these viral infections to lower respiratory tract may prove fatal, especially in HCT recipients. Increasing evidence on the successful use of ribavirin (alone or in combination with immunomodulators) for the treatment of respiratory syncytial virus infections in HM patients and HCT recipients is available from retrospective studies; however, prospective clinical trials are necessary to establish its efficacy with confidence. The impact on progression to pneumonitis and/or mortality of treating parainfluenza virus infections with available (ribavirin) or investigational (DAS181) antiviral agents still needs to be determined. Influenza infections have been successfully treated with neuraminidase inhibitors (oseltamivir or zanamivir); however, the efficacy of these agents for influenza pneumonia has not been established, and immunocompromised patients are highly susceptible to emergence of antiviral drug resistance, most probably due to prolonged viral shedding. Infection control measures and an appreciation of the complications following respiratory viral infections in immunocompromised patients remain crucial for reducing transmission. Future studies should focus on strategies to identify patients at high risk for increased morbidity and mortality from these infections and to determine the efficacy of novel or available antiviral drugs.

Keywords: RSV; antiviral therapy; cancer; immunocompromised host; infection prevention.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Hematologic Neoplasms / complications*
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Influenza, Human / drug therapy
  • Influenza, Human / etiology
  • Influenza, Human / virology
  • Paramyxoviridae Infections / drug therapy
  • Paramyxoviridae Infections / etiology
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / etiology
  • Recombinant Fusion Proteins / therapeutic use
  • Respiratory Syncytial Virus Infections / drug therapy
  • Respiratory Syncytial Virus Infections / etiology
  • Respiratory Tract Infections / drug therapy*
  • Respiratory Tract Infections / etiology
  • Respiratory Tract Infections / virology
  • Ribavirin / therapeutic use
  • Virus Diseases / drug therapy*
  • Virus Diseases / etiology

Substances

  • Antiviral Agents
  • DAS181
  • Recombinant Fusion Proteins
  • Ribavirin