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

Khawaja, Fareed; Chemaly, Roy F.

The mortality rate amongst HM patients with RSV can be as high as 18%. 4, 50 The mortality rate in a small study conducted in the mid-1990s was 80% among leukemia patients with RSV LRTI who had recently undergone myelosuppressive chemotherapy. 57 More recent studies of HM patients with RSV LRTI found mortality rates of 8% to 17% 37, 38, 58 This better outlook could be explained in part by the improvement in supportive care over the years and the use of ribavirin for the treatment of RSV in this population of patients. 37, 58 Risk factors associated with mortality in RSV-infected leukemia patients include neutropenia (≤500 neutrophils/mL), lymphopenia (≤200 lymphocytes/mL), and a high APACHE II score at diagnosis. 37, 58 These host factors reflect the patients' immune status and its ability to curtail the impact of RSV infections. The severity and stage of the infection (URTI vs. LRTI) or the virulence of the RSV may also affect mortality. In HM patients with proven LRTI, the 30-day mortality rate was reported to be 36% compared to 14% in patients with possible LRTI. 38 In a recent retrospective analysis, patients with HM, including HCT recipients, in whom respiratory viral infections were detected in the intensive care unit had a higher intensive care unit mortality rate, with the association being strongest when influenza, parainfluenza or RSV was detected. 10