Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Microbial Issues

Oral ribavirin for treatment of respiratory syncitial virus and parainfluenza 3 virus infections post allogeneic haematopoietic stem cell transplantation

Bone Marrow Transplantation volume 48, pages 1558–1561 (2013)Cite this article

Subjects

Abstract

The prognosis for patients with respiratory syncytial virus (RSV) or parainfluenza virus type 3 (PIV3) respiratory tract infection post allogeneic haematopoietic progenitor cell transplant (HPCT) is historically poor. The use of oral ribavirin (RBV) has not been widely studied in this patient population. We examined the outcomes of 15 consecutive patients (RSV, n=13 and PIV3, n=2) treated with oral RBV post HPCT. Oral RBV was commenced at a starting dose of 10 mg/kg/day, increasing to a maximum dose of 60 mg/kg/day depending on response and tolerance. At diagnosis, seven patients had upper respiratory tract infection (URTI) and eight had lower respiratory tract infection (LRTI). The starting RBV dose of 10 mg/kg/day did not prevent the progression of URTI to LRTI in any patient. However, with dose escalation, six of the seven patients responded to RBV therapy and survived their infective episode. Of the eight patients presenting with LRTI, six patients survived their infection, again after dose escalation of RBV. There was no dose-limiting toxicity seen in any patient. Our results indicate that oral RBV has clinical efficacy in the treatment of RSV/PIV3 infection post HPCT. However, a starting dose of 10 mg/kg/day appears ineffective; we recommend a starting dose of 20 mg/kg/day in this patient group.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Harrington RD, Hooton TM, Hackman RC, Storch GA, Osborne B, Gleaves CA et al. An outbreak of respiratory synsitial virus in a Bone Marrow transplant center. J Infect Dis 1992; 165: 987–993.

    Article  CAS  Google Scholar 

  2. Lewis VA, Champlin R, Englund J, Couch R, Goodrich JM, Rolston K et al. Respiratory disease due to parainfluenza virus in adult bone marrow transplant recipeints. Clin Infect Dis 1996; 23: 1033–1037.

    Article  CAS  Google Scholar 

  3. Nichols WG, Gooley T, Boeckh M . Community-acquired respiratory synsitial virus and parainfluenza virus infections after hematopoetic stem cell transplantation: The Fred Hutchinson Cancer Research Center experience. Biol Blood Bone Marrow Trans 2001; 7: 11s–15s.

    Article  Google Scholar 

  4. Wendt CW, Weisdorf DJ, Jordan C, Balfour HH, Hertz MI . Parainfluenza virus respiratory infection after bone marrow transplantation. NEJM 1992; 326: 921–926.

    Article  CAS  Google Scholar 

  5. Preston SL, Drusano GL, Glue P, Nash J, Gupta SK, McNamara P . Pharmacokinetics and absolute bioavailability of ribavirin in healthy volunteers as determined by stable-isotope methodology. Antimicrob Chemother 1999; 43: 2451–2456.

    Article  CAS  Google Scholar 

  6. Boeckh M, Englund J, Li Y, Miller C, Cross A, Fernandez H et al. Randomized controlled multicenter trial of aerosolized ribavirin for respiratory synsitial virus upper respiratory tract infection in hematopoetic cell transplant recipients. Clin Infect Dis 2007; 44: 245–249.

    Article  CAS  Google Scholar 

  7. Bowden RA . Respiratory virus infections after marrow transplant: the Fred Hutchinson Cancer Research Center Experience. Am J Med 1997; 102: 27–30.

    Article  CAS  Google Scholar 

  8. Sparrelid E, Ljunman P, Ekelof-Andstrom E, Aschan J, Ringden O, Winiarski J et al. Ribavirin therapy in bone marrow transplant recipients with viral respiratory tract infections. Bone Marrow Transplant 1997; 19: 905–908.

    Article  CAS  Google Scholar 

  9. Shah JN, Chemaly RF . Management of RSV infections in adult recipeints of hemopoetic stem cell transplant. Blood 2011; 117: 2755–2763.

    Article  CAS  Google Scholar 

  10. Lambert SB, Whiley DM, O’Neill NT, Andrews EC, Canavan FM, Bletchly C et al. Comparing nose-throat swabs and nasopharyngeal aspirates from children with symptoms for respiratory virus identification using real-time polymerase chain reaction. Pediatrics 2008; 122: e615–e620.

    Article  Google Scholar 

  11. Hisrsh HH, Martino R, Ward KN, Boeckh M, Einsele H, Ljungman P . Fourth European conference on infections in leukaemia (ECIL-4): guidelines for diagnosis and treatment of human respiratory syncytial virus, parainfluenza virus, metapneumovirus, rhinovirus and coronavirus. Clin Infect Dis 2013; 56: 256–266.

    Google Scholar 

  12. Avetisyan G, Mattsson J, Sparrelid E, Ljungman P . Respitarory syncytial virus infection in receipients of allogenic stem cell transplantation: a retropsective study of the incidence, clinical features and outcome. Transplantation 2009; 88: 1222–1226.

    Article  Google Scholar 

  13. Chemaly RF, Hanmod SS, Rathod DB, Ghantoji SS, Jiang Y, Doshi A et al. The characteristics and outcomes of parainfluenza virus infections in 200 patients with leukaemia or recipients of hematopoietic stem cell transplantation. Blood 2012; 19: 2738–2748.

    Article  Google Scholar 

  14. Elizaga J, Olivarria E, Apperley JF, Goldman JM, Ward KN . Parainfluenza virus 3 infection after stem cell transplant: relevance of outcome of rapid diagnosis and ribavirin treatment. Clin Infect Dis 2001; 32: 413–418.

    Article  CAS  Google Scholar 

  15. Hassan IA, Chopra R, Swindell R, Mutton KJ . Respiratory viral infections after bone marrow/peripheral stem-cell transplantation: the Christie hospital experience. Bone Marrow Transplant 2003; 32: 73–77.

    Article  CAS  Google Scholar 

  16. Hodson A, Kasliwal M, Streetly M, MacMahon E, Raj K . A parainfluenza-3 outbreak in SCT unit: sepsis with multi-organ failure and multiple co-pathogens are associated with increased mortality. Bone Marrow Transplant 2011; 46: 1545–1550.

    Article  CAS  Google Scholar 

  17. Khanna N, Widmer A, Decker M, Steffen I, Halter J, Heim D et al. Respiratory synsitial virus infection in patients with hematological disease: single-centre study and review of the literature. Clin Infect Dis 2008; 46: 402–412.

    Article  CAS  Google Scholar 

  18. Ljungman P, Ward KN, Crooks BNA, Parker A, Martino R, Shaw PJ et al. Respiratory virus infections after stem cell transplantation: a prospective study from the infectious diseases working party of the European group for blood and marrow transplantation. Bone Marrow Transplant 2001; 28: 479–484.

    Article  CAS  Google Scholar 

  19. Machado CM, Boas LSV, Mendes AVA, Santos MFM, da Rocha IF, Sturaro D et al. Low mortality rates related to respiratory virus infections after bone marrow transplantation. Bone Marrow Transplant 2003; 31: 695–700.

    Article  CAS  Google Scholar 

  20. Maziarz RT, Sridharan P, Slater S, Meyers G, Post M, Erdman D et al. Control of an outbreak of human parainfluenza virus 3 in hematopoetic stem cell transplant recipients. Biol Blood Marrow Transplant 2010; 16: 192–198.

    Article  Google Scholar 

  21. Nichols WG, Corey L, Gooley T, Davis C, Boeckh M . Parainfluenza virus infections after hematopoetic stem cell transplantation: risk factors, response to antiviral therapy, and effect on transplant outcome. Blood 2001; 98: 573–578.

    Article  CAS  Google Scholar 

  22. Chakrabarti S, Collingham KE, Holder K, Oyaide S, Pillay D, Milligan DW . Parainfluenza 3 virus type 3 infections in hematopoetic stem cell transplant recipients: response to ribavirin therapy. Clin Infect Dis 2000; 31: 1516–1518.

    Article  CAS  Google Scholar 

  23. Ariza-Heredia EJ, Fishman JE, Cleary T, Smith L, Razonable RR, Abbo L et al. Clinical and radiological features of respiratory syncytical virus in solid organ transplant recipients: a single-center experience. Transplant Infect Dis 2012; 14: 64–71.

    Article  CAS  Google Scholar 

  24. Glanville AR, Scott AI, Morton JM, Aboyoun CL, Plitt ML, Carter IW et al. Intravenous ribavirin is a safe and cost effective treatment for respiratory syncytial virus infection after lung transplantation. J Heart Lung Transplant 2005; 24: 2114–2119.

    Article  Google Scholar 

  25. Li L, Avery R, Budev M, Mossad S, Danziger-Isakov L . Oral virus inhaled ribavirin therapy for respiratory syncytical virus infection after lung transplantation. J Heart Lung Transplant 2012; 31: 839–844.

    Article  Google Scholar 

  26. Pelaez A, Lyon GM, Force SD, Ramiez AM, Neujahr DC, Foster M . Efficacy of oral ribavirin in lung transplant patients with respiratory syncytial virus lower respiratory tract infection. J Heart Lung Transplant 2009; 28: 67–71.

    Article  Google Scholar 

  27. Chakrabarti S, Collingham KE, Holder K, Fegan CD, Osman H, Milligan DW . Pre-emptive oral ribivirin therapy for paramyxomavirus infections after haematopoietic stem cell transplant: a pilot study. Bone Marrow Transplant 2001; 28: 759–763.

    Article  CAS  Google Scholar 

  28. Buckingham SC, Jafri HS, Bush AJ, Carubelli C, Sheerman P, Hardy RD et al. A randomised, double-blind, placebo-controlled trial of dexamethasone in severe respiratory syncytial virus (RSV) infection: effects on RSV quantity and clinical outcome. J Infect Dis 2002; 185: 1222–1228.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Haematology, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia

    J Casey, K Morris, M Narayana & G A Kennedy

  2. Pharmacy Department, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia

    M Nakagaki

  3. University of Queensland, St Lucia, Herston, Queensland, Australia

    G A Kennedy

Authors
  1. J Casey
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K Morris
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Narayana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M Nakagaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G A Kennedy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G A Kennedy.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Disclaimer

No financial assistance or support was received by any author for the conduct of this research.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Casey, J., Morris, K., Narayana, M. et al. Oral ribavirin for treatment of respiratory syncitial virus and parainfluenza 3 virus infections post allogeneic haematopoietic stem cell transplantation. Bone Marrow Transplant 48, 1558–1561 (2013). https://doi.org/10.1038/bmt.2013.112

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2013.112

Keywords

This article is cited by

Search

Advanced search

Quick links