Introduction: Community respiratory virus infections in the bone marrow transplant population

Abstract

B B & M T Community respiratory viruses (CRVs), including respiratory syncytial virus (RSV), influenza viruses, parainfluenza viruses, adenoviruses, and even rhinoviruses, are significant causes of respiratory infections and accompanying morbidity and mortality among bone marrow transplant (BMT) recipients. Although much progress has been made in prevention of these infections through infection-control programs, CRV infections that progress to pneumonia contribute significantly to mortality in the posttransplantation period. At a symposium in Keystone, Colorado, held in February 2001, speakers from 5 transplantation centers and the Centers for Disease Control and Prevention reviewed studies and guidelines on the management of CRV infections in BMT recipients. Janet A. Englund, MD, reviewed the epidemiology of CRV infections and the importance of early diagnosis, which has been facilitated by the availability of rapid diagnostic tests. Per Ljungman, MD, PhD, reviewed data from the prospective CRV epidemiology study, conducted under the auspices of the European Group for Blood and Marrow Transplantation at its 37 member centers. W. Garrett Nichols, MD, reviewed the experience with CRV infections in BMT recipients at the Fred Hutchinson Cancer Research Center during the past decade and described 2 ongoing prospective randomized controlled trials of treatment of RSV infection in adult BMT recipients. Roberta H. Adams, MD, reported on the results of a pilot trial of preemptive aerosolized ribavirin treatment of RSV infection in pediatric BMT patients, conducted at the University of Utah, and described the design of an ongoing controlled trial employing the same approach. Clare A. Dykewicz, MD, MPH, reviewed CRV prevention recommendations from the recently issued guidelines on preventing opportunistic infections in hematopoietic stem cell recipients, jointly developed by the Centers for Disease Control and Prevention, the Infectious Diseases Society of America, and the American Society for Blood and Marrow Transplantation. Finally, I reviewed the M.D. Anderson Cancer Center experience with CRV infections in BMT recipients and noted our progress in prevention and treatment of these life-threatening infections. Today, we have a good grasp of the measures we need to have in place to prevent CRV infections in this vulnerable patient population. Unfortunately, we currently lack data from controlled clinical trials that clearly support the efficacy of any particular therapy for serious respiratory tract infections due to RSV or parainfluenza virus in BMT recipients. There is, however, some indication—primarily for RSV infection—that early diagnosis and treatment with aerosolized ribavirin, with or without intravenous RSV immunoglobulin or monoclonal anti-RSV antibody, may modify the progression of upper respiratory infections to pneumonia and reduce mortality. The outcomes of ongoing trials described here should provide more guidance about when and how to treat CRV infections in BMT recipients. Introduction: Community Respiratory Virus Infections in the Bone Marrow Transplant Population