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

Khawaja, Fareed; Chemaly, Roy F.

In this review, we summarize the published data on RSV infections in adult HCT recipients and HM patients, focusing on recent findings. We highlight the incidence of RSV infections, risk factors associated with progression from upper respiratory tract infection (URTI) to lower respiratory tract infection (LRTI), other complications and outcomes (including mortality), management strategies including new agents under investigation, and prevention strategies. 30% to 37% of respiratory viral infections in this population, with approximately 19% to 36% of these infections resulting in LRTI. 4, 20 Determination of the true incidence of RSV infection among HCT recipients has been challenging, with a reported wide range of 5% to 49%, 5, 8, 18, [21] [22] [23] [24] [25] [26] [27] [28] as many studies included symptomatic patients diagnosed with different laboratory assays such as RSV antigen detection, identification of RSV by direct florescent antibody, viral cultures, and molecular assays in recent years (Table 1 ). In addition, the wide range of reported incidences of RSV infections could be due to the increased awareness of this virus over the years and its impact on immunocompromised patients. On the other hand, lower incidences of RSV infections were reported in studies in which molecular assays such as multiplex polymerase chain reaction were used to detect RSV, with the reported range in these cases being 8-30%. 8, 9, 29 This lower incidence could be explained by the increased rate of diagnosing other respiratory viruses, such as coronavirus, rhinovirus, and parainfluenza, with the use of molecular assays.