Incidence and Outcome of Rhinovirus in Children Undergoing Hematopoietic Stem Cell Transplantation

BACKGROUND:  Human rhinovirus (HRV) is well known to cause upper or lower respiratory tract infection (URTI/LRTI) and are associated with increased morbidity and mortality in immunocompromised adults such as those with cancer or those undergoing hematopoietic stem cell transplantation (HSCT).  Asymptomatic children who are about to undergo HSCT with a positive respiratory viral panel (RVP) pose a special challenge and create a dilemma for providers when deciding whether to move forward with HSCT in patients with active viral disease.  

METHODS:  We retrospectively reviewed the medical records of all children who underwent HSCT from Jan 1, 2006 – May 1, 2014 who had a RVP by PCR performed as part of the pretransplant workup or within 180 days following HSCT.   Patients with rhinovirus identified pretransplant were not treated with IVIG but received routine prophylaxis with IVIG. Patients who developed rhinoviral infection were treated with high dose IVIG. We reviewed data of all patients to evaluate its impact on overall outcome.  Demographic, clinical, microbiologic, management, and outcome data were collected.

RESULTS: 50 pediatric HSCT patients were identified. A total of 23 patients were asymptomatic and identified on pretransplant DFA screening. None of these patients developed complications related to rhinovirus during the transplant.   21 patients were identified after HSCT was started due to workup for fever or respiratory symptoms. None of these children appeared to have significant morbidity and mortality related to rhinoviral infection. Of note, 11/11 (100%) umbilical cord recipients continued to have positive RVP and viral shedding for several months following HSCT.     

CONCLUSIONS:   Rhinovirus does not appear to have a negative impact on the course of children undergoing HSCT.  The presence of rhinovirus is not a contraindication to proceeding to transplant in children.  Umbilical cord blood transplant patients appeared to have delayed clearance of the virus but this did not impact their clinical outcome.