2438. Respiratory syncytial virus in Hematopoietic Stem Cell Transplantation- Risk Stratification and Outcomes
Session: Poster Abstract Session: Viral Infections in Transplantation
Saturday, October 7, 2017
Room: Poster Hall CD


In hematopoietic stem cell transplant (HSCT) recipients, respiratory syncytial virus (RSV) can progress from upper respiratory tract infection (URTI) to lower respiratory tract infection (LRTI), causing substantial morbidity and mortality. At our center, we target treatment (aerosolized vs oral ribavirin) to the “highest” risk patients based on a local treatment guideline. Subsequently, an immunodeficiency scoring index for respiratory syncytial virus (ISI-RSV), has been published.  Our objective  was to identify the risk factors for progression from URTI to LRTI and mortality, particularly ISI-RSV score and ribavirin treatment received.


We reviewed forty adult HSCT recipients at the Cleveland clinic with RSV infection from January 2000 to December 2014, 28 presented with URTI and received oral ribavirin and 13 received inhaled ribavirin. Variables collected included those used to calculate ISI-RSV (in table), ribavirin treatment, and death, among others.

The ISI- RSV score include : low risk 0-2, intermediate risk 3-6, high risk 7-12.



Assigned weighted scores

ANC <500


ALC <200


Age > or equal to 40


Myeloablative conditioning regimen


GVHD (acute or chronic)


Corticosteroids within prior 30 d


Recent or pre-engraftment allo HSCT within prior 30 d



Progression to LRTI was estimated with cumulative incidence and risk factors identified with Fine and Gray regression. Survival was estimated with Kaplan-Meier and prognostic factors identified with Cox proportional hazards analysis. Results are presented as hazard ratio (HR) and 95% confidence interval (CI).



Progression from  URTI to LRTI occurred in 6 of 28 patients. Higher ISI-RSV score increased the risk of progression (HR 1.50, CI 1.02-2.18, P=0.037) but not death (HR 1.07, CI 0.86-1.34, P=0.55). The use of oral ribavirin did not increase risk of progression (HR 1.06, CI 0.13-8.67, P=0.96) or death .


The ISI-RSV did predict progression from URTI to LRTI, but initial treatment with oral ribavirin instead of aerosolized did not.  Limitations of this study include small sample size and low rate of the primary outcome, progression to LRTI. Future studies should focus on early identification and therapeutic interventions to prevent progression to LRTI.

Figure 1: Progression to LRTI based on ISI RSV
Progression to LRTI.tif

Survival ISI RSV.tif

Figure 2: Survival based on ISI RSV


Hashim Abbas, MBBS, MD, Department of Hospital Medicine, Cleveland clinic, Cleveland, OH, Lisa Rybicki, MS, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, Donna Abounader, Research supervisor, Cleveland clinic, cleveland, OH, Sherif Mossad, MD, FIDSA, Infectious Diseases, Cleveland Clinic Foundation, Cleveland, OH, Navneet Majhail, MD, MS, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH and Eric Cober, MD, Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH


H. Abbas, None

L. Rybicki, None

D. Abounader, None

S. Mossad, None

N. Majhail, None

E. Cober, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.