Adjunctive palivizumab with ribavirin for respiratory syncytial virus infection during the early peri-transplant period in adult allogenic hematopoietic stem cell transplant recipients: Case series.

BACKGROUND

Respiratory syncytial virus (RSV) is associated with significant morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients, particularly during the peri-transplant period. Therapeutic options remain limited, and the role of adjunctive RSV-specific immunotherapy is unclear. We evaluated the outcomes of palivizumab combined with ribavirin in high-risk adult HSCT recipients with RSV infection.

METHODS

We retrospectively reviewed adult HSCT recipients with RT-PCR-confirmed RSV infection who received palivizumab and ribavirin. Clinical characteristics, treatment timing, outcomes, adverse events, and mortality were assessed.

RESULTS

Three adult allogeneic HSCT recipients who developed RSV infection between (day - 4 to day +2) were identified. Two patients survived, who had moderate- to high-risk disease according to the Immunodeficiency Scoring Index (ISI-RSV), while one patient with high-risk disease developed progressive respiratory failure and died despite intensive therapy, likely due to concomitant mucormycosis. No treatment-related adverse events were observed. Earlier initiation of ribavirin and palivuzumab, and the intravenous route of palivuzumab, were observed in the two cases who achieved complete recovery.

CONCLUSIONS

Adjunctive palivizumab appears to be safe and may be a useful therapeutic option for HSCT recipients with RSV infection during the peri-transplant period. Larger prospective studies are needed to define the optimal role, timing, and route of palivizumab administration in this high-risk population.