HSR21-074: Respiratory Viral Infections Continue to be an Unresolved Problem in the Care of Immunocompromised Transplant Patients

Background and Objectives: Respiratory viral infections (RVIs) are associated with significant morbidity and mortality following hematopoietic stem cell transplantation (HSCT) and solid organ transplantation (SOT). Management in this high risk population remains very challenging without an established gold standard of care for these patients. The objectives of this medical questionnaire were to: (1) determine the current clinical state of infections caused by viral pathogens in the face of the COVID 19 pandemic; (2) identify the most common respiratory viral pathogens; (3) explore current management approaches and prescriber satisfaction; and (4) explore unmet need and future therapies. Methods: This prospective medical questionnaire was distributed between September 16 and October 18, 2020 to key opinion leaders (KOLs) at major transplant centers, both HSCT and SOT. The questionnaire was administered by a third party with individual results being blinded. The online platform captured the following: demographics, practice site information, pathogen identification and frequency, management strategies for RVIs including respiratory syncytial virus (RSV), and measured provider satisfaction with currently available modalities. Data was summarized with descriptive statistics. Results: Twenty-six KOLs from transplant centers (100% academic; 40% NCCN) completed the questionnaire. Over 60% of respondents considered lower respiratory tract viral infections to be “problematic” with nearly 20% categorizing as a “growing concern”. The most common RVIs in prevalence were: RSV 20%, influenza 17.6%, parainfluenza 13.6%, human metapneumovirus 12%, and cytomegalovirus 8%. There was a wide range of strategies with no consensus on the optimal management of RVIs caused by RSV or other respiratory viruses. Nearly 50% noted that there were “no proven available options and an unmet needs exists” while another 38.5% stated “available options, but no consensus standard of care”. Approximately 50% of respondents would be likely to use an intravenous immune globulin product that has elevated levels of antibody to RSV and other viral pathogens. Conclusion: RVIs continue to be a problematic issue facing providers who care for immunocompromised transplant patients. Management strategies vary substantially with no clear consensus and an unmet need exists. Novel therapies are warranted to help combat RVIs in this highly susceptible patient population.