555 - Oral Ribavirin for the Treatment of Respiratory Syncytial Virus (RSV) and Human Metapneumovirus (hMPV) Infections in Hematology Patients and Stem Cell Transplant (SCT) Recipients at a Nci-Designated Cancer Center

Abstract

Background: Respiratory infections cause morbidity and increased mortality in immunosuppressed populations. These patients are at an increased risk of an upper respiratory tract infection (URTI) progressing to a lower respiratory tract infection (LRTI) leading to fatal pneumonia. Ribavirin is a purine analog that is active against RNA and DNA viruses. Aerosolized ribavirin is approved for use in children with RSV pneumonia, and has been used for treatment of RSV and hMPV infections in immunosuppressed adults. Ribavirin is available in oral formulation for the treatment of hepatitis C but there is an increasing trend to utilize it for RSV and hMPV infections. At our center, a standardized protocol was developed and implemented for treatment of these infections with oral ribavirin. Methods: Retrospective chart review of patients treated with oral ribavirin for RSV or hMPV during a 5-year period. Results: Over the 5-year period, 62 patients were treated with oral ribavirin for RSV or hMPV respiratory infections. Majority of patients were male, and the majority of infections were RSV (68%). The patient population was evenly split between hematology and SCT. The most common hematologic malignancy was acute myelogenous leukemia and of the SCT recipients, most were allogeneic (24 of 31). Majority of the cases presented with findings of upper and lower tract infection (42%), with 13 and 23 patients having symptoms consistent only with URTI and LRTI, respectively. Seasonal correlation was noted, with almost 90% of infections occurring between October and May and infections were hospital acquired in one third of the cases (21 of 62). In addition to ribavirin, intravenous immunoglobulin (IVIG) was administered in 15 of the 62 patients, 13 with document IgG levels of <400 mg/dL at diagnosis. The median treatment duration was 10 days (range 2-29), with only 6 patients discontinuing the drug due to side effects. Three patients required intubation with an overall 8% (5 of 62 patients) infection related mortality while on oral ribavirin treatment. All patients that expired had RSV. Conclusion: This retrospective review suggests that oral ribavirin, with or without IVIG, is a well-tolerated option for treating RSV and hMPV infection in patients with hematologic malignancies or after SCT.