Are We Overlooking the Use of Oral Ribavirin for Respiratory Syncytial Virus Infection Following Hematopoietic Stem Cell Transplantation?

Background Respiratory syncytial virus (RSV) is a common cause of respiratory infection following HSCT. We describe our experience using oral ribavirin (RBV) for RSV infections in HSCT recipients. Methods Retrospective cohort analysis of HSCT recipients diagnosed with RSV infection and treated with either oral RBV or supportive care between September 2014 and April 2015. Results Twenty-six HSCT recipients were identified as RSV-positive in this study. Oral RBV (mean daily dose 16.7 mg kg) was prescribed to 14 (54%) patients. A higher proportion of patients in the RBV group had lower respiratory tract infection (RTI) ( p = 0.007) and were inpatient ( p < 0.001) at diagnosis, with a higher proportion of acute graft-versus-host disease (GVHD) among patients with GVHD ( p = 0.06), and more frequent prednisone ( p = 0.045) or methylprednisolone use ( p = 0.008). There was a higher frequency of oxygen requirement ( p = 0.035) and longer hospital stays ( p < 0.001) in the RBV group, but RSV-related mortality and progression from upper to lower RTI were not more frequent. Leukopenia and hemolysis were also not more frequent in the RBV group. Conclusions Oral RBV appears to be well tolerated, but its benefit in RSV infections remains unclear. Randomized controlled trials are needed to further evaluate its safety and efficacy at escalating doses in this patient population.