Management of Respiratory Viral Infections in Hematopoietic Cell Transplant Recipients and Patients With Hematologic Malignancies
Management of Respiratory Viral Infections in Hematopoietic Cell Transplant Recipients and Patients With Hematologic Malignancies
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DOI：
10.1093/cid/ciu623
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发表时间：
2014-11-15
影响因子：
11.8
通讯作者：
Boeckh, Michael J.
中科院分区：
文献类型：
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作者：
Chemaly, Roy F.;Shah, Dimpy P.;Boeckh, Michael J.
尽管采取了预防措施并提高了意识，但血液恶性肿瘤（HMs）患者和造血细胞移植（HCT）患者中呼吸道病毒感染的发生率仍然很高。这些病毒感染进展到下呼吸道可能是致命的，特别是在HCT接受者中。回顾性研究表明，利巴韦林（单独使用或与免疫调节剂联合使用）成功用于治疗HM患者和HCT接受者的呼吸道合胞病毒感染的证据越来越多；然而，前瞻性临床试验是必要的，以确定其有效性的信心。使用现有（利巴韦林）或研究性（DAS181）抗病毒药物治疗副流感病毒感染对肺炎进展和/或死亡率的影响仍需确定。神经氨酸酶抑制剂（奥司他韦或扎那米韦）已成功治疗流感感染；然而，这些药物对流行性肺炎的疗效尚未确定，免疫功能低下的患者极易出现抗病毒药物耐药性，这很可能是由于病毒脱落时间较长。感染控制措施和对免疫功能低下患者呼吸道病毒感染后并发症的认识对于减少传播仍然至关重要。未来的研究应侧重于确定这些感染的发病率和死亡率增加的高风险患者的策略，并确定新型或现有抗病毒药物的疗效。
Despite preventive strategies and increased awareness, a high incidence of respiratory viral infections still occur in patients with hematologic malignancies (HMs) and in recipients of hematopoietic cell transplant (HCT). Progression of these viral infections to lower respiratory tract may prove fatal, especially in HCT recipients. Increasing evidence on the successful use of ribavirin (alone or in combination with immunomodulators) for the treatment of respiratory syncytial virus infections in HM patients and HCT recipients is available from retrospective studies; however, prospective clinical trials are necessary to establish its efficacy with confidence. The impact on progression to pneumonitis and/or mortality of treating parainfluenza virus infections with available (ribavirin) or investigational (DAS181) antiviral agents still needs to be determined. Influenza infections have been successfully treated with neuraminidase inhibitors (oseltamivir or zanamivir); however, the efficacy of these agents for influenza pneumonia has not been established, and immunocompromised patients are highly susceptible to emergence of antiviral drug resistance, most probably due to prolonged viral shedding. Infection control measures and an appreciation of the complications following respiratory viral infections in immunocompromised patients remain crucial for reducing transmission. Future studies should focus on strategies to identify patients at high risk for increased morbidity and mortality from these infections and to determine the efficacy of novel or available antiviral drugs.