Respiratory syncytial virus in hematopoietic cell transplant recipients and patients with hematologic malignancies

Khawaja, Fareed; Chemaly, Roy F.

Despite our experience with aerosolized ribavirin for the treatment of RSV infections in adult HCT recipients and its increase in popularity over the years, a major shift to the oral formulation occurred around 3 years ago, at least at our institution, when the cost of ribavirin increased drastically. 85 Oral ribavirin has been used to treat RSV URTI or LRTI in both HCT recipients and HM patients. 79, 81, 82, [86] [87] [88] The dosing regimens vary between a weight-based regimen of 15 mg/kg to 60 mg/kg to a standardized dosage of 600 mg-800 mg twice daily or 600 mg three times daily for a maximum of 1800 mg/day. Oral ribavirin is more readily available than is aerosolized ribavirin and is well tolerated, on the basis of data on its longterm use in patients with hepatitis C virus infections. 89 In a retrospective analysis of our experience with aerosolized ribavirin and the recent switch to oral ribavirin, we found no significant differences in outcomes, including progression to LRTI and day 30 or 60 all-cause mortality, in HCT recipients with RSV infections. 90 On the basis of the results of a recent analysis, we propose the use of oral ribavirin as a viable alternative to aerosolized ribavirin (Figure 1 ). At our institution, we implemented a decision-making treatment algorithm as guidance for our clinical providers. HCT recipients are stratified on the basis of their RSV-ISI score and stage of RSV diagnosis (URTI vs. LRTI).