autologous blood and marrow transplantation - Blog Science ...

714 Chapter 15: New Avenues
physical discomfort to the patients of prolonged aerosol therapy and confinement
within a scavenging tent; the adverse effects of aerosolized ribavirin, such as
bronchospasm; the high cost of these drugs as well as the intensive respiratory
therapy needed to safely administer aerosolized ribavirin; and the need for hospitalization
with more frequent or prolonged ribavirin dosing regimens. Studies are
underway to define more closely the patients at risk and to identify the regimen that
is simplest to administer and least costly yet effective.
Although prompt therapy of URIs with antiviral drugs and/or immunotherapy
appears to have had a favorable impact on the frequency of pneumonia and death,
the morbidity and mortality associated with RSV infections in these patients is still
high. The optimal therapy is prevention. Active immunoprophylaxis is not an
option, because an effective vaccine is not currently available. Passive immunoprophylaxis
appears promising in high-risk young children and warrants investigation
in immunocompromised patients. In children, the monthly administration of
RSV-IVIG (Respigram, Medimmune), a human polyclonal IgG immune globulin
with high RSV microneutralization titers, has been effective in decreasing the risk
of serious RSV disease, as has the monthly administration of monoclonal RSV
antibody (MEDI-493, Medimmune), a humanized monoclonal antibody. 22-24
Prevention of infection through an aggressive infection control strategy can be
highly effective. 8
At the core of an effective strategy is continuing education of
patients, family members, visitors, and staff regarding the potential seriousness of
CRV infections, their epidemiology, their modes of transmission, and means of
control. In general, infection control strategies need to be designed to prevent
spreading by several different modes of transmission, since several different CRVs
commonly circulate in the community concurrently and since CRVs usually can be
spread by several modes of transmission. These measures may need to be
intensified during community or hospital outbreaks of CRV infections. The
intensity and duration of the infection control measures need to be tailored
according to the risk of serious CRV in different subsets of transplant recipients
and the needs of the patient and quality of life issues.
CONCLUSION
The spectrum of emerging viruses and their disease manifestations in blood and
marrow transplant recipients has evolved rapidly. In addition, traditional
herpesviruses such as CMV are posing new challenges, particularly in the late
posttransplant period, and are becoming the model for a new modality of therapy,
adoptive immunotherapy. 25
' 26
Sophisticated diagnostic research tools are gradually
being integrated into the clinical diagnostic laboratories, and clinical investigations
are being undertaken to define the sensitivity and specificity of these assays and to
distinguish shedding of virus from disease. The need for more effective and less