Influenza in patients with hematological malignancies: Experience at two comprehensive cancer centers

• Published in: Journal of medical virology Vol. 90; no. 1; pp. 50 - 60
• Main Authors: Vilar‐Compte, Diana, Shah, Dimpy P., Vanichanan, Jakapat, Cornejo‐Juarez, Patricia, Garcia‐Horton, Alejandro, Volkow, Patricia, Chemaly, Roy F.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-01-2018
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Albumin; Antiviral Agents - therapeutic use; Cancer; Child; Child, Preschool; Coinfection - virology; Complications; Confidence intervals; Corticosteroids; Creatinine; Diagnosis; Female; H1N1; Health care; Hematologic Neoplasms - complications; Hematologic Neoplasms - virology; Hematology; Humans; Hypoxia; Immunocompromised Host; Infant; Infections; Influenza; Influenza, Human - complications; Influenza, Human - drug therapy; Influenza, Human - mortality; Influenza, Human - virology; Leukemia; Logistic Models; lymphoma; Male; Mexico - epidemiology; Middle Aged; myeloma; Patients; pneumonia; Regression analysis; Respiration; Respiratory tract; Respiratory tract diseases; Respiratory Tract Infections - complications; Respiratory Tract Infections - virology; Retrospective Studies; Serum Albumin - analysis; Statistical analysis; United States - epidemiology; Virology; Young Adult; influenza; leukemia; myeloma; pneumonia; lymphoma; cancer; H1N1
• ISSN: 0146-6615; 1096-9071
• DOI: 10.1002/jmv.24930

The burden of influenza infections in patients with hematological malignancies (HMs) is not well defined. We describe the clinical presentation and associated outcomes of influenza at two comprehensive cancer centers (center 1 in the United States and center 2 in Mexico). Clinical and laboratory data on patients with HMs and influenza infection diagnosed from April 2009 to May 2014 at the two centers were reviewed retrospectively. A total of 190 patients were included, the majority were male (63%) with a median age of 49 years (range, 1‐88 years), and had active or refractory HMs (76%). Compared to center 1, patients in center 2 were significantly sicker (active cancer, decreased albumin levels, elevated creatinine levels, or hypoxia at influenza diagnosis) and experienced higher lower respiratory tract infection (LRI) rate (42% vs 7%; P < 0.001). In multivariable logistic regression analysis (odds ratio, 95% confidence interval), leukemia, (3.09, 1.23‐7.70), decreased albumin level (3.78, 1.55‐9.20), hypoxia at diagnosis (14.98, 3.30‐67.90), respiratory co‐infection (5.87, 1.65‐20.86), and corticosteroid use (2.71, 1.03‐7.15) were significantly associated with LRI; and elevated creatinine level (3.33, 1.05‐10.56), hypoxia at diagnosis (5.87, 1.12‐30.77), and respiratory co‐infection (6.30, 1.55‐25.67) were significantly associated with 60 day mortality in both centers. HM patients with influenza are at high risk for serious complications such as LRI and death, especially if they are immunosuppressed. Patients with respiratory symptoms should seek prompt medical care during influenza season.
Influenza infections in patients with hematological malignancies differed significantly between two cancer centers. Patient education about seeking prompt medical care during influenza season is highly recommended.