Respiratory Viral Infections in Adults With Hematologic Malignancies and Human Stem Cell Transplantation Recipients

Abstract

Community respiratory viruses (CRVs) have been recognized as a potential cause of pneumonia and death among hematopoietic stem cell transplantation (HSCT) recipients and patients with hematologic malignancies. We reviewed the Microbiology Laboratory records dated from July 1, 2000, to June 30, 2002, to identify patients who had respiratory specimens positive for influenza, parainfluenza, respiratory syncytial virus, or picornavirus. We identified 343 infections among patients with underlying hematologic malignancies and HSCT. We collected data on type of disease, age, sex, type of infection, neutrophil and lymphocyte counts, therapy, and outcome. Influenza, parainfluenza, and respiratory syncytial virus accounted for most cases and were approximately equal in frequency. Most infections occurred predominantly among recipients of allogeneic transplants. Infection progressed to pneumonia in 119 patients (35%) and occurred with similar frequency for the 3 viruses. Patients at greatest risk for developing pneumonia included those with leukemia, those aged more than 65 years, and those with severe neutropenia or lymphopenia. Lack of respiratory syncytial virus-directed antiviral therapy (p=0.025) and age (p=0.042) were associated with development of respiratory syncytial virus pneumonia, and an absolute lymphocyte count<or=200 cells/mL (p=0.049) was associated with development of influenza pneumonia. The overall mortality rate for CRV pneumonia was 15%. The only independent predictor of fatal outcome was an absolute lymphocyte count<or=200 cells/mL (p=0.03) in patients with influenza pneumonia.HSCT recipients and patients with hematologic malignancies who develop upper respiratory infection due to CRVs should be considered for antiviral therapy of proven efficacy to reduce the risk of pneumonia and death.

Risk factors and containment of respiratory syncytial virus outbreak in a hematology and transplant unit

“…This is consistent with our observation that hypogammaglobulinemia was associated with fatal outcome. Other risk factors, such as age 33 or RSV infection pre-engraftment, 32,34,35 were not statistically significant in our univariate or multivariate analysis. We also did not find any significant difference in median time to RSV infections in hematology and transplant unit N Lehners et al leukocyte recovery in patients infected before versus after engraftment, as found by others.…”

Immunogenicity of a monovalent influenza A(H1N1)pdm09 vaccine in patients with hematological malignancies

“…4 It is said that their treatment with cytotoxic chemotherapy drugs induced a reduction of humoral response and led to increased susceptibility to infectious disease. [5][6][7] In fact, high mortality and morbidity of this population due to an influenza virus was reported. 8 On the other hand, it is unclear whether the underlying disease causes this lowered response.…”

Clinical features and outcome of 2009-influenza A (H1N1) after allogeneic hematopoietic SCT

“…Interestingly, LRTI, prolonged viral shedding, hospitalization, longer antiviral treatment, ventilator requirement and H1N1 resistance were documented only in SID patients. Lymphopenia, which has been previously reported as a risk factor for LRTI, both for community-acquired RVI [1][2][3][4]33 and for H1N1 influenza 9,[14][15][16][17][18]26 was observed in six patients at the time of diagnosis. Chronic GvHD and its corollary of long-term immunosuppression has also been associated with the risk of developing RVI and LRTI.…”