Treatment of respiratory syncytial virus infection in haemopoietic stem cell transplant recipients with aerosolized ribavirin and the humanized monoclonal antibody palivizumab: a single centre experience.

摘要

Palivizumab is a humanized monoclonal antibody against respiratory syncytial virus (RSV). We report our experience on its use in patients undergoing haemopoietic stem cell transplantation (HSCT). Over a period of two years, palivizumab was administered to eight HSCT recipients with documented RSV infection (Table I). Its use was an individual decision of the treating physician in each case. All patients received aerosolized ribavirin at a dose of 2 g tds for 5 d, and a single intravenous infusion of 15 mg/kg of palivizumab within 3 d of diagnosis. The dose and route of administration were based on a previous phase I study on HSCT patients (Boeckh et al, 2001). RSV infection was demonstrated by immunofluorescence (IF) and polymerase chain reaction (PCR) in five patients, by IF alone in two, and by PCR alone in one patient, on nasopharyngeal aspirates (NPA). One patient was also positive on bronchoalveolar lavage (BAL). According to our protocol, response to treatment was assessed by repeat NPA 7 d after treatment. All eight patients had symptomatic RSV infection. Cough and coryzal symptoms were common features for all, whereas five patients also had fever at presentation. There was radiological evidence of chest infection (plain radiographs and/or computed tomography) for at least four patients and at least two patients were hypoxic at the beginning of treatment (oxygen saturation <95%). Six patients were lymphopenic (