Differences in clinical outcomes after 2009 influenza A/H1N1 and seasonal influenza among hematopoietic cell transplant recipients

• Published in: Blood Vol. 117; no. 19; pp. 5050 - 5056
• Main Authors: Choi, Su-Mi, Boudreault, Alexandre A., Xie, Hu, Englund, Janet A., Corey, Lawrence, Boeckh, Michael
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 12.05.2011; Americain Society of Hematology; American Society of Hematology
• Subjects: Adolescent; Adult; Antiviral Agents - therapeutic use; Biological and medical sciences; Clinical Trials and Observations; Female; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation; Human viral diseases; Humans; Infectious diseases; Influenza A Virus, H1N1 Subtype - physiology; Influenza, Human - complications; Influenza, Human - epidemiology; Influenza, Human - virology; Male; Medical sciences; Middle Aged; Retrospective Studies; Transplantation; Viral diseases; Viral diseases of the respiratory system and ent viral diseases; Young Adult; Infection; Prognosis; Hematology; Respiratory disease; H1N1 influenza; Viral disease; Hematopoietic cell; Influenza A; Recipient
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2010-11-319186

It is not known whether pandemic 2009 influenza A/H1N1 (2009 H1N1) leads to more serious disease than seasonal influenza in hematopoietic cell transplant (HCT) recipients. In a retrospective study in HCT recipients with virologically proven influenza virus infection, a total of 161 HCT recipients (18 2009 H1N1, 103 seasonal influenza A, and 40 seasonal influenza B) were analyzed. In multivariable analyses, more patients with 2009 H1N1 had lower respiratory tract disease (LRD), hypoxemia, and prolonged viral shedding compared with seasonal influenza A. Seasonal influenza A and B outcomes were similar. There was no difference in overall and influenza-associated mortality among influenza virus types. Both early and delayed administration of antiviral therapy was shown to be beneficial in terms of decreased rates of development of LRD, although earlier intervention appeared to be more effective. Profound lymphopenia and lack of early antiviral therapy were associated significantly with LRD, hypoxemia, and death. High-dose corticosteroid treatment (≥ 1 mg/kg) given at the time of influenza diagnosis was associated with a reduced risk for mechanical ventilation. Thus, our data suggest that infection with 2009 influenza A/H1N1 resulted in more severe respiratory disease in HCT recipients compared with seasonal influenza.