Pandemic 2009 H1N1 Influenza in Patients with Hematopoietic Stem Cell Transplantation and Hematologic Malignancy: Single Center Experience

Abstract

Although valuable information on many aspects of the pandemic 2009 H1N1 influenza came to light in a relatively short period of time, the disease course among immunocompromised patients is largely unknown. In this study, we present the results of active H1N1 surveillance in 32 patients who were treated at our hematology/stem cell transplantation clinic between December 2009 and January 2010. We also report the clinical and laboratory features of patients with laboratory-proven disease and try to define the impact of novel H1N1 disease on their outcome. Eight patients in the hematology clinic and 7 patients in the hematology/stem cell transplantation unit tested positive for pandemic H1N1 infection. Patients were treated with oral oseltamivir for 5–15 days. In 10 patients the infection was limited to the upper respiratory tract. But in 5 patients it was complicated with lower respiratory diseases. Three of them required intensive care support with mechanic ventilation and all died during follow-up. As the clinical and radiological findings of H1N1 infection are nonspecific in nature, we should have a high index of suspicion in immunocompromised patients. Therefore, beginning empiric oseltamivir therapy while waiting for laboratory results and increasing the dose/duration of therapy in laboratory-confirmed cases could be life saving.

Influenza in patients with cancer after 2009 pandemic AH1N1: An 8‐year follow‐up study in Mexico

“…Symptoms presented by our patients were similar to those described in non-immunosuppressed patients, [3][4][5]7,11,13,15,20 frequent complaints. Patients with HM presented with more fever than patients with solid tumors.…”

“…Symptoms presented by our patients were similar to those described in non‐immunosuppressed patients, despite it has been suggested that immunocompromised patients might develop severe influenza without classical symptoms. Cough, fever, malaise with bone and muscle pain, rhinorrhea, and chills were frequent complaints.…”

Virological Clearance Rate of High-Dose Oseltamivir or Triple-Combination Antiviral Therapy in Complicated 2009 Pandemic Influenza A (H1N1) Infection

“…Although there are concerns regarding possible neuropsychiatric reactions to highdose oseltamivir (16), a high dose has generally been found to be safe (17). Several reports noted that severely ill patients may benefit from high-dose oseltamivir therapy (18)(19)(20)(21). There were no adverse events related to high-dose oseltamivir in the present study.…”

European guidelines for prevention and management of influenza in hematopoietic stem cell transplantation and leukemia patients: summary of ECIL‐4 (2011), on behalf of ECIL, a joint venture of EBMT, EORTC, ICHS, and ELN

“…Some centers report relatively mild 2009 A/H1N1 influenza disease in HSCT recipients, mainly in children , with others reporting severe pandemic A/H1N1 2009 influenza . The largest study of the pandemic A/H1N1 2009 influenza included 64 European HSCT centers reporting 286 patients, 222 after allogeneic transplantation and 64 after autologous HSCT.…”