A multicenter study of pandemic influenza A (H1N1) infection in patients with solid tumors in 3 countries

Abstract

BACKGROUND: Pandemic influenza A (hereafter 2009/H1N1) caused significant morbidity and mortality during the 2009 pandemia. Patients with chronic medical conditions and immunosuppressive diseases had a greater risk of complications. However, data regarding the characteristics and outcome of 2009/H1N1 infection in patients with solid tumors are nonexistent. Herein, the authors describe a series of influenza 2009/H1N1 in patients with solid malignancies at 3 major cancer hospitals worldwide. METHODS: The authors retrospectively reviewed the records of patients with solid organ malignancies and 2009/H1N1 from The University of Texas M. D. Anderson Cancer Center in Houston, Texas; the Mexican National Cancer Institute, Federal District of Mexico; and King Hussein Cancer Center in Amman, Jordan from the period of the 2009 H1N1 pandemia. Data on demographics, disease characteristics, and outcome were extracted. RESULTS: In total, 115 cases were identified during the pandemic influenza among the 3 institutions. High rates of hospitalization (50%), pneumonia (23%), and death (9.5%) were reported. Patients who developed pneumonia and those who died were moderately to severely immunocompromised (P = .001 and P = .006, respectively). A multivariate competing risk analysis demonstrated that a delay >48 hours in starting antiviral therapy was associated significantly with an increased risk of developing pneumonia (P = .013). CONCLUSIONS: The 2009/H1N1 pandemic caused severe illness in immunocompromised patients with cancer who had solid tumors, and heavily immunosuppressed patients were at greater risk of developing pneumonia and death. Early initiation of antiviral therapy is crucial in this patient population to decrease morbidity and probably mortality. Cancer 2012. © 2012 American Cancer Society.

Pandemic 2009 Influenza A (H1N1) virus infection in cancer and hematopoietic stem cell transplant recipients; a multicenter observational study.

“…The incidence of pneumonia we found is higher than the one reported with seasonal influenza in cancer patients (5–44%) 3, 18– 20 and it is also higher than the incidence of lower respiratory tract infections (LRTI) caused by the 2009 pandemic Influenza A H1N1 in the hospitalized general population (40–44%) 21 , in solid organ transplant recipients (23%) 16 , in HCT recipients (21–56%) 1, 6, 8, 12– 14, 22 and in patients with hematological malignancies (48%) 23 . Only one small study that includes 15 confirmed cases of 2009 pandemic Influenza A H1N1 infection in onco-hematological patients reports a higher incidence of pneumonia (87%) 15 .…”

“…It was reported that delaying therapy in cancer patients with the pandemic Influenza A H1N1 virus infection was significantly associated with death 16 . Early initiation of antiviral therapy in these patients may attenuate the severity of disease 21, 27 .…”

“…Many studies from different countries were reported 1, 6– 16 . In these studies, the incidence of pneumonia ranges from 20 11 to 52% 8 , while the reported mortality rate ranges from 0–10% 6, 11, 12, 14, 16 to as high as 21–31% 7– 10, 15 .…”

Practical review of immunizations in adult patients with cancer

“…Clinicians have become increasingly aware of the risk of infection associated with the malignancy itself and/or immunosuppressive therapies, including higher risk for pneumococcus, influenza infection and hepatitis B among others. [1][2][3][4] In general, adults with oncological diseases should be advised to adhere to standard recommended immunization schedules, but they should avoid live vaccines while on immunosuppressive therapy. Types of immunizations are review in Table 1.…”

Challenges in Infectious Diseases for Haematologists

“…Although the clinical course of most infections is harmless, in some cases lower respiratory tract infections (LRTI) may occur, which are associated with a high attributable mortality, primarily due to severe bacterial and fungal superinfections [18]. Current data suggest an overall rate of LRTI of around 30% possibly for all CRV [19,20,21,22] with an associated mortality rate of around 25%. …”