1549. A Multicenter Study of Pandemic H1N1 Influenza (pH1N1) Infections in Patients with Hematologic Malignancies (HM) and Hematopoietic Cell Transplant (HCT) Recipients from 3 Countries
Session: Poster Abstract Session: Infections in the Immunocompromised Hosts
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • H1N1 poster edited final.pdf (859.4 kB)
  • Background: pH1N1 infections caused significant morbidity and mortality in young healthy individuals. Adverse outcomes were more significant in patients with cancer. However, data are scarce on characteristics and outcomes of these infections in HM patients and HCT recipients, in particular.

    Methods: We evaluated the characteristics, management (including oseltamivir antiviral therapy), and outcomes of all pH1N1 infections and determined the risk factors associated with pneumonia and all-cause mortality in HM patients and HCT recipients at 3 major cancer centers from April 2009 to December 2010: MD Anderson Cancer Center (MDACC), Texas; the Instituto Nacional de Cancerologia (INCan), Mexico; and King Hussein Cancer Center, Jordan. 

    Results: In total, 203 patients, including 158 (78%) HM patients and 45 (22%) HCT recipients were identified among the 3 institutions. Majority of patients (132, 65%) were adults, and males (116, 57%) with underlying malignancy in remission (114, 56%). We report high rates of hospitalization (125, 62%), pneumonia (74, 36%), and death (31, 15%). Mean duration of oseltamivir was 10 days (range: 1 – 28 days). Multivariable logistic regression analysis identified lymphocytopenia (ALC<200 cells/mL), a delay of >24 h in starting antiviral therapy, and being at INCan as significant risk factors for developing pneumonia and death in HM patients and HCT recipients (all, p <0.05). However, when compared to MDACC, patients at INCan were younger, with higher proportion with leukemia on active chemotherapy, and more were on steroids at time of diagnosis (all, p<0.05). Obesity was not an independent risk factor for either of these outcomes.

    Conclusion: Early initiation of antiviral therapy is crucial in this patient population to decrease morbidity and mortality following pH1N1 infections, especially in those at high risk due to underlying lymphocytopenia, younger age, and being on steroids. The impact of this infection was more pronounced in patients admitted to INCan.

    Jakapat Vanichanan, MD1, Diana Vilar-Compte, MD, MsC2, Dimpy P. Shah, MD, MSPH1, Patricia Volkow, MD3, Patricia Cornejo-Juarez, MD2, Carolina Perez-Jimenez, MD4, Mustafa Saad, MD5, Victor E. Mulanovich, MD1, Ella Ariza-Heredia, MD1 and Roy F. Chemaly, MD, MPH, FIDSA, FACP1, (1)Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, (2)Instituto Nacional De Cancerologia, Mexico City, Mexico, (3)Infectious Diseases Department, Instituto Nacional de Cancerologia, Mexico City, Mexico, (4)Infectious diseases, Instituto Nacional Cancerologia Mexico, Mexico City, Mexico, (5)King Hussein Cancer Center, Amman, Jordan

    Disclosures:

    J. Vanichanan, None

    D. Vilar-Compte, None

    D. P. Shah, None

    P. Volkow, None

    P. Cornejo-Juarez, None

    C. Perez-Jimenez, None

    M. Saad, None

    V. E. Mulanovich, None

    E. Ariza-Heredia, None

    R. F. Chemaly, None

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