Respiratory viral infections an increasing concern in HSCT
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Respiratory viral infections are becoming a more prevalent concern among clinicians who care for patients who undergo hematopoietic stem cell transplantation, according to findings presented at TCT Meetings Digital Experience.
Results revealed considerable variation in management strategies for this population, with no clear consensus among providers.
“There is a need to develop more effective therapies,” Gene A. Wetzstein, PharmD, BCOP, executive director and head of scientific engagement with ADMA Biologics, a commercial biopharmaceutical firm, and colleagues wrote. “Novel therapies are warranted to help combat respiratory viral infections in this highly susceptible population.”
Respiratory viral infections contribute to considerable morbidity and mortality among HSCT recipients. Up to 50% of patients whose infections progress to the lower respiratory tract die.
No established standard of care exists, making management of these patients a challenge, according to study background.
Wetzstein and colleagues sought to identify the most common respiratory viral infection pathogens among HSCT recipients, evaluate current management strategies for patients who develop viral infections in the lower respiratory tract and glean insights into the potential for future therapies that may address the unmet needs of this population. The researchers also aimed to determine the state of lower respiratory tract infections caused by viral pathogens amid the COVID-19 pandemic.
They distributed a prospective medical questionnaire to key opinion leaders at major HSCT centers in the United States between mid-September and mid-October 2020. A third party administered the questionnaire and individual results were blinded.
The online platform captured respondents’ demographics, practice site information, management strategies for respiratory viral infections, satisfaction with available treatment modalities, and pathogen identification and frequency.
Twenty-four key opinion leaders from pediatric and adult HSCT centers completed the questionnaire.
More than 80% characterized lower respiratory tract viral infections as problematic and an increasing concern with no established standard of care. Twelve (50%) identified lower respiratory tract infections as an unmet need with no proven available options; eight (33%) reported having available options but no consensus or standard of care; and four (16.6%) indicated they were satisfied with available options or had a well-established standard of care.
The most common respiratory viral infections respondents reported identifying in HSCT recipients were respiratory syncytial virus (83.3%), influenza (75%), parainfluenza (58.3%), human metapneumovirus (50%) and cytomegalovirus (33.3%).
Respondents identified a range of strategies for respiratory viral infections caused by respiratory syncytial virus or other respiratory viruses, with no consensus about optimal management.
The most frequently administered regimens consisted of ribavirin (50%) with IV immunoglobulin (27%) or without. Eight percent of respondents reported administering steroids and 15% reported administering supportive care.
Half of respondents indicated they would be very likely (4%) or likely (46%) to use an IV immunoglobulin product that has elevated levels of antibody to respiratory syncytial virus and other viral pathogens. Thirteen percent indicated they would be unlikely to use this type of product and 8% indicated they would be very unlikely to do so.
The majority of respondents (62.5%) indicated they expect the number of HSCTs this year will remain the same despite the COVID-19 pandemic. Three (12.5%) indicated they expect the number will increase by 5% to 25%, and four (16.6%) said they believe the number will decrease by 5% to 25%.
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Wetzstein GA, et al. Abstract LBA14. Presented at: The 2021 TCT Meetings Digital Experience (virtual meeting); Feb. 8-12, 2021.
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