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Volume 16, Number 12—December 2010

CME ACTIVITY - Research

Pandemic (H1N1) 2009 Infection in Patients with Hematologic Malignancy

Catherine LiuComments to Author , Brian S. Schwartz, Snigdha Vallabhaneni, Michael Nixon, Peter V. Chin-Hong, Steven A. Miller, Charles Chiu, Lloyd Damon, and W. Lawrence Drew
Author affiliations: Author affiliation: University of California, San Francisco, California, USA

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Table 2

Clinical features, treatments, and outcomes for hematologic malignancy patients who had URTI and LRTI from pandemic (H1N1) 2009 virus, University of California San Francisco Medical Center, San Francisco, California, USA, June–December 2009*

Characteristic Total, n = 27 URTI, n = 17 LRTI, n = 10 p value†
Signs and symptoms
Fever 19 (70) 11 (65) 8 (80) 0.44
Cough 23 (85) 14 (82) 9 (90) 0.68
Shortness of breath 11 (41) 2 (12) 9 (90) <0.01
Myalgias 4 (15) 3 (18) 1 (10) 0.50
Rhinorrhea 12 (44) 11 (65) 1 (10) 0.005
Sore throat 8 (30) 6 (35) 2 (20) 0.31
Gastrointestinal symptoms‡ 5 (19) 3 (18) 2 (20) 0.66
Household influenza exposure§
8 (30)
1 (6)
7 (70)
0.001
Laboratory values
  ALC, cells/μL, median (range) 570 (0–16,370) 815 (150–16,370) 130 (0–1,860)¶ 0.02
  Absolute neutrophil count <500 cells/μL
5 (19)
3 (19)
2 (20)
0.66
Treatment#
Antiviral drug therapy 21 (78) 11 (65) 10 (100) 0.042
Symptom onset to start of antiviral drug therapy, h**
<48 4 (19) 3 (27) 1 (10) 0.29
48–96 5 (24) 2 (18) 3 (30) 0.50
>96 11 (52) 5 (45) 6 (60) 0.50
Type of antiviral drug therapy
Oseltamivir, standard dose 8 (38) 5 (45) 3 (30) 0.65
Oseltamivir, high dose†† 11 (52) 4 (36) 7 (70) 0.02
Zanamivir, inhaled 2 (10) 0 2 (20) 0.13
Zanamivir, intravenous 1 (5) 0 1 (10) 0.37
Median duration of antiviral drug therapy, d (range) 7 (5–49) 5 (5–14) 15 (5–49) 0.058
Intravenous immunoglobulin
6 (22)
1 (9)
5 (50)
0.015
Outcome
Hospitalization 16 (59) 6 (35) 10 (100) 0.001
Intensive care unit admission 5 (19) 0 5 (50) 0.003
Mechanical ventilation 4 (15) 0 4 (40) 0.012
Death 3 (11) 0 3 (30) 0.041

*Values are given as no. (%) patients except as indicated. URTI, upper respiratory tract infection; LRTI, lower respiratory tract infection; ALC, absolute leukocyte count.
†p value represents statistical difference between comparison of values of patients with LRTI and URTI.
‡Nausea, vomiting, and/or diarrhea.
§Exposure to an ill household contact documented in patient’s chart.
¶Two LRTI patients had ALC below the level of detection, and the value was reported by the laboratory as <100 lymphocytes/μL. For this calculation, these patients were assigned an ALC value of 0.
#The calculation for LRTI excludes 2 patients who received only 2–3 d of antiviral therapy just before they died because their anticipated duration of antiviral therapy would have been longer.
**Time of symptom was available for 20 of 21 patients who received antiviral therapy.
††Two patients received standard-dose and high-dose oseltamivir.

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