472. Successful treatment of parainfluenza virus (PIV) respiratory infection with DAS181 in 3 immunocompromised children
Session: Poster Abstract Session: Prevention and Treatment of Viral Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDWeek 2013_092613.pdf (1.0 MB)
  • Background: PIV, a common pediatric pathogen, is associated with significant morbidity in immunocompromised (IC) hosts. DAS181, a novel sialidase fusion protein inhibitor, appears to be effective against PIV in vitro and in vivo; its use in IC children has not been evaluated.

    Methods: We describe 3 IC children with PIV lower respiratory tract infection (LRTI) who were treated with inhaled DAS181. PIV was detected from respiratory samples by RT-PCR using a semi-quantitative method. Medical records were reviewed.

    Results: Patients 1 and 2 were diagnosed with PIV LRTI by bronchoalveolar lavage at 9 months (M) and 2 days following allogeneic hematopoietic cell transplantation (HCT), respectively. Patient 3 was on chemotherapy prior to planned autologous HCT at time of PIV diagnosis from a nasal swab. All 3 patients had clinical symptoms and chest imaging consistent with LRTI. Inhaled DAS181 was administered for 5-10 days. All 3 patients tolerated therapy well. Clinical improvement in oxygen requirement (FiO2) and respiratory rate (RR) was observed in all 3 patients. Viral load (VL) decreased in all patients within one week of therapy, and became undetectable by day 3 of therapy in patient 3.

    Conclusion: DAS181 was used to treat 3 severely IC pediatric patients with PIV disease. The drug was well tolerated. Improvement in both viral loads and symptoms following initiation of therapy was observed in all cases. This report supports prospective, randomized studies in IC patients with PIV infection.

     

    Pt

    Age/ Sex

    Disease

    Transplant

    Onset

    PIV type

    Symptoms/Radiographic findings

    DAS181 Treatment

    Lab abnormalities

    Outcome

    1

    12y M

    Relapsed ALL

    Double cord

    9 M post-Tx

    PIV-3

    New O2 requirement, ↑resp distress, ground glass opacities on CT/CXR

    10mg/day x 10 days (dry powder)

    ↑alkaline phosphatase; ↑LFTs

    ↓FiO2, RR, VL; successful HCT

    2

    7m M

    SCID

    Double cord

    2 M pre-Tx; LRTI day+2

    PIV-2

    ↑FiO2, fever, wheezing, ↑infiltrates on CXR/CT

    0.14mg/kg/day x 5 days (nebulized)

    ↑aPTT, PT, TT, INR

    ↓FiO2, RR, VL; successful HCT

    3

    4y M

    Stage IV neuro- blastoma

    Autologous

    1 M pre-Tx

    PIV-3

    ↑cough, fever, crackles, new infiltrates on CXR/CT

    0.14mg/kg/day x 5 days (nebulized)

    ↑alkaline phosphatase

    ↓VL; went on to successful HCT

    ALL: acute lymphoblastic leukemia; SCID: severe combined immunodeficiency

     

    Alpana Waghmare, MD1,2,3, Thor Wagner, MD1,2, Robert Andrews, MD1,2,3, Sherilyn Smith, MD1,2, Jane Kuypers, PhD2, Ronald Moss, MD4 and Janet A. Englund, MD, FIDSA1,2, (1)Seattle Children's Hospital, Seattle, WA, (2)University of Washington, Seattle, WA, (3)Fred Hutchinson Cancer Research Center, Seattle, WA, (4)Ansun Biopharma, San Diego, CA

    Disclosures:

    A. Waghmare, None

    T. Wagner, None

    R. Andrews, None

    S. Smith, None

    J. Kuypers, None

    R. Moss, Ansun BioPharma: Employee, Salary

    J. A. Englund, PIDS: Board Member,
    Chimerix: Investigator, Research support
    Gilead: Investigator, Research support
    Novartis: Investigator, Research support
    GlaxoSmithKline: Consultant, Consulting fee

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