Influenza Infections after Hematopoietic Stem Cell Transplantation: Risk Factors, Mortality, and the Effect of Antiviral Therapy (original) (raw)

Journal Article

,

Clinical Research Division, Fred Hutchinson Cancer Research Center

,

Seattle, Washington

Reprints or correspondence: Dr. W. Garrett Nichols, Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, Seattle, WA 98109-4417 (wgnick2000@yahoo.com).

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Clinical Research Division, Fred Hutchinson Cancer Research Center

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Seattle, Washington

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Clinical Research Division, Fred Hutchinson Cancer Research Center

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Seattle, Washington

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Clinical Research Division, Fred Hutchinson Cancer Research Center

,

Seattle, Washington

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Published:

01 November 2004

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W. Garrett Nichols, Katherine A. Guthrie, Lawrence Corey, Michael Boeckh, Influenza Infections after Hematopoietic Stem Cell Transplantation: Risk Factors, Mortality, and the Effect of Antiviral Therapy, Clinical Infectious Diseases, Volume 39, Issue 9, 1 November 2004, Pages 1300–1306, https://doi.org/10.1086/425004
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Abstract

Background. Community-acquired respiratory viruses, such as influenza virus, are thought to be major causes of morbidity and mortality in patients who had undergone hematopoietic stem cell transplantation (HSCT). Risk factors for acquisition, progression to pneumonia, and the effect of antiviral therapy are unknown.

Methods. We reviewed records from patients with documented influenza over 12 consecutive respiratory-virus infection seasons at a single transplantation center.

Results. From 1 September 1989 through 31 March 2002, influenza virus was isolated from 62 of 4797 persons undergoing HSCT (1.3%); 44 patients had upper respiratory tract infections (URIs) alone, and 18 developed pneumonia. Among patients with influenza virus infection, pneumonia developed more commonly among those infected earlier after transplantation (median, 36 vs. 61 days, P = .04) and those with concurrent lymphopenia. Of the 51 cases that were initially diagnosed as URIs, 17 were treated with antivirals, and 34 were not treated. Six untreated patients (18%) developed pneumonia, whereas 1 (13%) of 8 patients treated with rimantadine and 0 of 9 treated with oseltamivir developed pneumonia. The duration of influenza virus shedding was longer in patients treated with steroid doses of >1 mg/kg than among those treated with doses of <1 mg/kg (mean, 15 vs. 9 days); there was a trend towards decreased shedding with oseltamivir therapy (but not rimantadine therapy) after controlling for steroid use (P < .08). The 30-day mortality rate was highest among patients who had progression to pneumonia (5 [28%] of 18 patients); pulmonary copathogens (such as Aspergillus fumigatus) were commonly isolated.

Conclusions. Influenza virus infection is an important cause of mortality early after HSCT. Our nonrandomized data suggest that early antiviral therapy with neuraminidase inhibitors may prevent progression to pneumonia and decrease viral shedding, which may prevent both influenza-related death in index patients and nosocomial transmission to others.

© 2004 by the Infectious Diseases Society of America

Topic:

• influenza
• hematopoietic stem cell transplantation
• antiviral agents
• lymphopenia
• orthomyxoviridae
• pneumonia
• rimantadine
• steroids
• virus shedding
• infections
• mortality
• transplantation
• viruses
• oseltamivir
• neuraminidase inhibitors
• community

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