Benign outcome of RSV infection in children with cancer

High case-fatality rates have been reported among adults who develop respiratory syncytial virus (RSV) infection while being treated for oncologic diseases, particularly after bone marrow transplantation. Previous reports of RSV infection among children with primary and acquired immunodeficiencies describe increased morbidity compared with that seen in immunocompetent children, but there have been few reports describing the outcome of RSV infection specifically among pediatric oncology patients.

We retrospectively reviewed the charts of all children being treated by the Pediatric Oncology Service at Memorial Sloan-Kettering Cancer Center who had positive tests for RSV between the Fall of 1994 and the Spring of 1998. Patients on the BMT Service were excluded from this analysis.

Eighteen RSV infections were identified among pediatric oncology patients, who were being treated with aggressive, predominantly alkylator-based chemotherapy for a variety of oncologic diagnoses. Nine episodes of RSV infection (50%) were treated with specific antiviral therapy. Only one death less than 100 days from the diagnosis of RSV infection occurred among these 18 patients and was attributed to progressive leukemia. The remaining patients recovered fully, although three were readmitted with respiratory symptoms within two weeks of discharge. Seven patients had concurrent infection with other pathogenic organisms.

In striking contrast with the outcome of RSV infection in adult oncology patients, there may be low mortality associated with RSV infection in pediatric oncology patients. It is possible that scheduled anti-neoplastic therapy need not be delayed for these patients when the diagnosis of RSV infection is made.