Antiviral Prophylaxis after Transplantation – pro

The immediate post stem cell transplantation period is a dangerous time in which the patient is immunocompromised and susceptible to infections. Viral infections are among the most dangerous because they are difficult to treat. Unfortunately not much is know about prophylaxis. Ribavirin alone is not appropriate for post-transplant prophylaxis without evidence of infection because supporting literature is scant. The respiratory viruses (eg, RSV, influenza, parainfluenza, rhinovirus) do not have a standard treatment protocol. Ribavirin treatment has been attempted (15-20 mg/kg/d IV divided q8h or the inhalation form). Success of ribavirin in treating these infections has been inconsistent. Most information on such use is in a case report form.

In two recent studies, the addition of RSV immune globulin (palivizumab at 15 mg/kg IM monthly) to traditional ribavirin therapy has shown promise in preventing the progression of RSV upper respiratory infection(URI) to lower respiratory disease and also in the treatment of RSV pneumonia. The key is being vigilant about URI and making the diagnosis quickly. It is imperative to determine the etiology of a URI in an stem cell recipient, if possible, because respiratory syncytial virus (RSV), influenza, parainfluenza, and adenovirus URIs can progress to more serious Lower Respiratory Infection. Appropriate routine diagnostic samples to investigate URO in recent transplant recipients include nasopharyngeal washes, swabs or aspirates; throat swabs (in combination with nasal samples); and bronchoalveolar lavage (BAL) fluid. Without an URI, prophylactic use of Ribavirin alone is currently experimental.

Jharna N. Shah and Roy F. Chemaly, Management of RSV infections in adult recipients of hematopoietic stem cell transplantation
Blood March 10, 2011 vol. 117 no. 10 2755-2763

D. McCoy, E. Wong, A.G. Kuyumjian, M.A. Wynd, R. Sebti, G.B. Munk. Treatment of respiratory syncytial virus infection in adult patients with hematologic malignancies based on an institution-specific guideline. Transpl Infect Dis 2011: 13: 117–121.

Marcie Tomblyn, Tom Chiller, Hermann Einsele, Ronald Gress, Kent Sepkowitz, Jan Storek,
John R. Wingard, Jo-Anne H. Young, Michael A. Boeck Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplantation Recipients: A Global Perspective Biol Blood Marrow Transplant 15: 1143-1238 (2009)

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