Advances in
stem cell transplantation procedures and the overall improvement in the clinical management of hematopoietic cell transplant (HCT) recipients over the past 2 decades have led to an increase in survival duration, in part owing to better strategies for prevention and treatment of post-transplant complications, including
opportunistic infections. However, post-HCT
infections remain a concern for HCT recipients, particularly
infections caused by community respiratory viruses (CRVs), which can lead to significant morbidity and mortality. These viruses can potentially cause lower respiratory tract illness, which is associated with a higher mortality rate among HCT recipients. Clinical management of CRV
infections in HCT recipients includes supportive care and
antiviral therapy, especially in high-risk individuals, when available. Directed
antiviral therapy is only available for
influenza infections, where successful use of
neuraminidase inhibitors (
oseltamivir or
zanamivir) and/or M2 inhibitors (
amantadine or
rimantadine) has been reported. Data on the successful use of
ribavirin, with or without
immunomodulators, for
respiratory syncytial virus infections in HCT recipients has emerged over the past 2 decades but is still controversial at best because of a lack of randomized controlled trials. Because of the lack of directed
antiviral therapy for most of these viruses, prevention should be emphasized for healthcare workers, patients, family, and friends and should include the promotion of the licensed inactivated
influenza vaccine for HCT recipients, when indicated. In this review, we discuss the clinical management of respiratory viruses in this special patient population, focusing on commercially available
antivirals, adjuvant
therapy, and novel drugs under investigation, as well as on available means for prevention.