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Updated: Jul 15, 2026
An In vitro Model to Study Immune Responses of Human Peripheral Blood Mononuclear Cells to Human Respiratory Syncytial Virus Infection
Published on: December 10, 2013
Palivizumab prophylaxis to prevent respiratory syncytial virus mortality after pediatric bone marrow transplantation:
Neal J Thomas1, Christopher S Hollenbeak, Gary D Ceneviva
1Department of Pediatrics, Division of Pediatric Critical Care Medicine, Penn State Children's Hospital, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, USA. nthomas@psu.edu
Insights
Palivizumab may improve survival in pediatric bone marrow transplant (BMT) patients at risk of respiratory syncytial virus (RSV) lung disease. This analysis suggests treating 12 children could save one life, highlighting the need for further trials.
Area of Science:
- Pediatric Hematology/Oncology
- Infectious Diseases
- Clinical Decision Analysis
Background:
- Respiratory Syncytial Virus (RSV) poses a significant threat to immunocompromised children, particularly those post-bone marrow transplantation (BMT).
- Palivizumab, a monoclonal antibody, is proven safe and effective for RSV prevention in young children, but its efficacy in post-BMT pediatric patients is not well-established.
- The lack of randomized controlled trials necessitates alternative methods to evaluate palivizumab's impact in this vulnerable population.
Purpose of the Study:
- To evaluate the potential effectiveness of palivizumab in preventing RSV-induced morbidity and mortality in pediatric patients following bone marrow transplantation (BMT).
- To utilize decision analysis methodology to model the impact of palivizumab on survival rates in this specific patient group.
Main Methods:
- A decision tree model was constructed to assess mortality associated with RSV lung disease in pediatric BMT recipients.
- Probabilistic data for the model were obtained through meta-analysis of existing literature.
- Sensitivity analyses were conducted across a wide range of plausible probabilities to ensure the model's robustness.
Main Results:
- The decision analysis indicated a 10% increase in survival for BMT patients receiving palivizumab.
- The absolute survival rate improved from 83% to 92% in the modeled scenario.
- The number needed to treat (NNT) to prevent one death from RSV-related lung disease in post-BMT children was calculated to be 12.
Conclusions:
- Decision analysis modeling suggests that palivizumab can decrease mortality from RSV-related lung disease in pediatric BMT patients.
- The findings support the potential benefit of incorporating palivizumab into the management of RSV risk in this population.
- A robust, randomized controlled trial is essential to definitively confirm these modeled outcomes.
Objective:
Palivizumab, a monoclonal antibody against respiratory syncytial virus (RSV), has been demonstrated to be safe and effective in young children, but evidence is lacking as to whether palivizumab is effective in preventing RSV-induced morbidity and mortality in children who are immunosuppressed after bone marrow transplantation (BMT). As a randomized, double-blind, placebo-controlled trial is lacking, we chose to examine this issue with the use of decision analysis methodology.
Methods:
A decision tree was designed to determine mortality from RSV-related lung disease in children who received palivizumab after BMT. Probabilities were derived by meta-analysis methodology on the basis of the available literature. Sensitivity analyses were performed across a broad range of biologically plausible probabilities to judge the robustness of the results of the model.
Results:
The model revealed that there is a 10% increase in survival in BMT patients who receive palivizumab. The absolute survival rate increased from 83% to 92%. A practitioner would need to treat 12 children to save 1 post-BMT child from dying from RSV-related lung disease.
Conclusions:
Decision analysis modeling demonstrates a decrease in mortality in pediatric BMT patients with the addition of palivizumab to protect against RSV-related lung disease. A well-designed, randomized controlled trial is necessary.
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