1280. Oxygen-free days and mortality among hematopoietic cell transplant recipients with respiratory syncytial virus (RSV) infection
Session: Poster Abstract Session: Clinical Infectious Diseases: Respiratory Infections
Friday, October 28, 2016
Room: Poster Hall
Posters
  • IDweek 2016 FINAL.pdf (270.4 kB)
  • Background: RSV causes significant morbidity and mortality in hematopoietic cell transplant (HCT) recipients. We evaluated relationships between RSV disease, oxygen requirement, and mortality.

    Methods: 230 HCT recipients with RSV infection from 2003-15 were grouped by presentation: Group 1- Upper respiratory tract infection (URTI) without progression to lower respiratory tract infection (LRTI), Group 2- URTI with progression to LRTI, and Group 3- LRTI at presentation. URTI was defined as a positive RSV result from an upper tract sample only; LRTI as a positive lower tract sample with or without radiographic abnormality (proven or probable LRTI, respectively) or a positive upper tract sample with radiographic abnormality (possible). Oxygen free days were defined as any day on ≤2L of oxygen while alive from day 0-28 following RSV diagnosis.

    Results: The need for >2L of oxygen from day 0-28 following RSV diagnosis was significantly different among groups (Table).Oxygen use in Group 1 patients (N = 142) and those with possible LRTI in Groups 2 (N = 28) and 3 (N = 19) was minimal; significant oxygen use was seen in patients with proven/probable LRTI. Group 3 patients with proven/probable LRTI were alive and oxygen free for a median of 16 days less than those in group 1 (Figure). Death by day 28 only occurred among patients with proven/probable LRTI (Table).

    Conclusion: Patients with proven/probable LRTI have the fewest oxygen free days and are the only patients to die within 28 days following RSV diagnosis. Confirmation of RSV LRTI with bronchoalveolar lavage provides useful prognostic information and may help prioritize expensive and intensive therapeutic options. These observations suggest oxygen free days represent a potentially useful surrogate for mortality and may allow smaller sample sizes for clinical trials evaluating RSV antivirals in HCT recipients.

     

    Table

     

     

    Group 1

    (N = 142)

    Group 2

    Group 3

    All Group 2

    (N = 54)

    Possible LRTI

    (N = 28)

    Proven/probable LRTI

    (N = 26)

    All Group 3

    (N = 34)

    Possible LRTI

    (N = 19)

    Proven/probable LRTI

    (N = 15)

    >2L oxygen use at RSV diagnosis

    3 (2%)

    6 (11%)

    2 (7%)

    4 (15%)

    16 (47%)

    6 (32%)

    10 (67%)

    >2L oxygen use from day 0-28 after RSV

    8 (6%)

    23 (43%)

    6 (21%)

    17 (65%)

    21 (62%)

    9 (47%)

    12 (80%)

    Death by day 28

    0 (0%)

    4 (7%)

    0 (0%)

    4 (15%)

    5 (15%)

    0 (0%)

    5 (33%)

    Alpana Waghmare, MD1,2,3, Hu Xie, MS4, Louise Kimball, RN, PhD2, Jessica Yi, BS2, Sezan Ozkok, MD2, Wendy Leisenring, ScD4, Janet Englund, MD, FIDSA1,3, Timothy Watkins, MD5, Jason Chien, M.D.5 and Michael Boeckh, MD, FIDSA2,6, (1)Pediatrics, University of Washington, Seattle, WA, (2)Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, (3)Pediatric Infectious Diseases, Seattle Children's Hospital, Seattle, WA, (4)Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, (5)Gilead Sciences, Inc., Foster City, CA, (6)Department of Medicine, University of Washington, Seattle, WA

    Disclosures:

    A. Waghmare, Gilead: Investigator , Research support

    H. Xie, None

    L. Kimball, None

    J. Yi, None

    S. Ozkok, None

    W. Leisenring, None

    J. Englund, Pfizer: Consultant and Investigator , Research grant and Speaker honorarium
    Gilead: Consultant and Investigator , Consulting fee and Research support
    GlaxoSmithKline: Investigator and Member Data Safety Monitoring Board , Hourly payment for DSMB work and Research support
    Alios: Investigator , Research support
    Roche: Investigator , Research support

    T. Watkins, None

    J. Chien, None

    M. Boeckh, Merck: Consultant and Investigator , Consulting fee and Research support
    Shire: Consultant , Consulting fee
    Chimerix: Consultant and Investigator , Consulting fee and Research support
    Astellas: Consultant and Investigator , Consulting fee and Research support
    Microbiotix: Consultant , Consulting fee
    Clinigen: Consultant , Consulting fee
    Gilead: Investigator , Research support

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