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Oral ribavirin for severe adenovirus infection after allogeneic marrow transplantation

Bone Marrow Transplantation volume 32, pages 1107–1108 (2003)Cite this article

Adenovirus-induced hemorrhagic cystitis (AD-HC) is a recognized cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT).1,2 It is especially a problem after HSCT from unrelated donors because of more profound immunosuppression and more severe.3,4 AD-HC is sometimes accompanied by pneumonia, renal infection and viremia resulting in death.2 Intravenous ribavirin has been reported to be useful in AD-HC.4,5,6 Oral ribavirin has been used for hepatitis C, but its role in adenovirus infections is unclear.

In the current report, oral ribavirin was successfully used in the patient with severe adenovirus infection. Oral ribavirin has been widely used in the treatment of hepatitis C virus infection; however, to the best of our knowledge, this is the first report of oral ribavirin for adenovirus infection. The dose and the duration of oral ribavirin for the treatment of adenovirus infection after HSCT are not established. Initially, we used an equivalent dose of intravenous ribavirin as recommended by NCI pharmaceutical company for Lassa fever. In the second treatment, we used 125% dose of that in the first one. After the second treatment, the myelosuppression was observed. Myelosuppression has been reported in a similar situation.5 Hemolysis is a well-known adverse effect of ribavirin.7 However, caution should be taken for the severe myelosuppression by ribavirin after HSCT. It is reported that bioavailability of oral ribavirin is approximately 50%.8 The appropriate dose may be 200% of the recommended intravenous dose. In the current report, a lower dose of ribavirin was used resulting in the immediate remedy of the disease. The persistent virus in urine may be explained by the low dose of ribavirin, in part; however, myelosuppression developed even with the low dose of ribavirin, suggesting that the full dose of ribavirin may cause severe myelosuppression in the transplant setting.

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Authors and Affiliations

  1. Department of Rheumatology and Hematology, Tohoku University School of Medicine, Sendai, Japan

    S Abe, K Miyamura & T Sasaki

  2. Department of Internal of Medicine, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    K Miyamura, T Oba, S Terakura, M Kasai, K Kitaori & Y Kodera

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  1. S Abe
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  2. K Miyamura
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  8. Y Kodera
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Abe, S., Miyamura, K., Oba, T. et al. Oral ribavirin for severe adenovirus infection after allogeneic marrow transplantation. Bone Marrow Transplant 32, 1107–1108 (2003). https://doi.org/10.1038/sj.bmt.1704276

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