Treatment of rotavirus-associated diarrhea using enteral immunoglobulins for pediatric stem cell transplant patients

Abstract

Diarrhea is a common complication associated with allogeneic and autologous stem cell transplant patients. One potential cause of viral diarrhea is rotavirus gastroenteritis. This study represents a single-center experience of using multiple daily doses of enteral immunoglobulins in four pediatric hematopoietic stem cell transplant patients with confirmed rotavirus infections. Four courses of enteral immunoglobulin administration were included for analysis. Clinical characteristics recorded included duration of diarrhea symptoms, frequency of bowel movements, and consistency of stool. Four single courses of enteral immunoglobulins in four patients were included for analysis. Patient age range was from 10 months to 14 years. Three out of four courses observed displayed an improvement in diarrhea frequency and/or stool consistency. Median time from therapy initiation to symptom improvement was three days. At a median 22-month follow-up, one patient was diagnosed with gastrointestinal graft-versus-host disease. The time to rotavirus symptom resolution was decreased, compared to historical controls, and improvement in stool frequency and consistency was observed in three of four courses. One case of gastrointestinal graft-versus-host disease was observed after nearly two years of follow-up. Enteral administration of immunoglobulins may represent a valid clinical option for hematopoietic stem cell transplant patients with rotavirus diarrhea.

Use of oral immunoglobulins to treat diarrhea in pediatric kidney transplant recipients—Single‐center experience and review of the literature

“…We found improvement in all and complete resolution of prolonged diarrhea in 3 of the 4 oral IgG recipients within a median of 3 days. This is consistent with other small studies: Oral IgG has been a successful therapy for chronic diarrhea in two children with primary immunodeficiency, six stem cell recipients with rotavirus‐associated diarrhea . Favorable effect of oral IgG on diarrhea has also been described in adult, but not in pediatric, small bowel, lung, and kidney transplant recipients .…”

“…This is consistent with other small studies: Oral IgG has been a successful therapy for chronic diarrhea in two children with primary immunodeficiency, six stem cell recipients with rotavirus‐associated diarrhea . Favorable effect of oral IgG on diarrhea has also been described in adult, but not in pediatric, small bowel, lung, and kidney transplant recipients . A retrospective study of 12 lung transplant recipients with norovirus‐associated diarrhea found complete symptom resolution in 11 patients .…”

“…Duration reported in the literature ranges from a single dose to several months of treatment . The cumulative dose in our patients ranged from 50 to 1500 mg/kg while the doses reported in the literature for transplant recipients range from 200 to 1400 mg/kg . Guarino et al published one of the earlier studies on the use of oral IgG for rotavirus and used the dose of 300 mg/kg.…”

“…oral IgG is considered effective in preventing rotavirus‐associated gastroenteritis in low‐birthweight infants and shortens the duration of acute gastroenteritis in hospitalized children . Oral IgG may also be effective in ameliorating rotavirus‐ and norovirus‐associated diarrhea in adult stem cell and solid organ recipients . Oral IgG has not been studied in pediatric solid organ transplant recipients.…”

“…7 Oral IgG may also be effective in ameliorating rotavirus-and norovirus-associated diarrhea in adult stem cell and solid organ recipients. [8][9][10][11][12][13] Oral IgG has not been studied in pediatric solid organ transplant recipients.…”