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Volume 16, Number 12—December 2010

CME ACTIVITY

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 3

Selected cases of severe pandemic (H1N1) 2009 infection in patients with hematologic malignancy, University of California San Francisco Medical Center, San Francisco, California, USA, June–December 2009*

Patient no./ age, y/sex Underlying disease, time frame ALC† Neutro Onset of symptoms, d before antiviral therapy Antiviral therapy; duration, d Duration of viral
shedding, d‡ Hospital acquired ICU/
mechanical ventilation, d Complications; outcome
1/43/M
APML, 9 d post auto-SCT
<100†
Yes
6
SD/HD oseltamivir;§ 40 d
26
Yes
25/8
Myocarditis, cardiogenic shock; survived
2/48/M
HIV, Burkitt lymphoma
<100†
Yes
7
HD oseltamivir;
2 d
Unknown
Yes
5/4
ARDS; died
3/45/F
DLBCL, 1 year post auto-SCT, BCNU pneumonitis
80
No
5
HD oseltamivir, inhaled/IV zanamivir;
49 d
48
No
40/13
Oseltamivir resistance; died
4/75/M
Multiple myeloma
40
No
7
HD oseltamivir;
2 d
Unknown
Yes
4/3
ARDS, died
5/29/M ALL, 1-m post allo-SCT 160 No 3 HD oseltamivir; 20 d 7 No 8/0 Pneumomediastinum; pneumopericardium, bronchiolitis obliterans; survived

*ALC, absolute lymphocyte count/μL; Neutro, neutropenia; ICU, intensive care unit; APML, acute promyelocytic leukemia; SCT, stem cell transplant; SD, standard dose; HD, high dose; DLBCL, diffuse large B-cell lymphoma; IV, intravenous; BCNU, carmustine. ARDS, adult respiratory distress syndrome; ALL, acute lymphocytic leukemia.
†Two patients had an ALC below the level of detection, and the laboratory reported the value as <100 cells/μL.
‡This time is the minimum estimated duration of viral shedding calculated on the basis of the time between the first positive to the last positive specimen collected. Because there was no standard collection interval between specimens and specimens were not collected >1 time weekly, viral shedding may have been longer than indicated. For example, patient 5 had 2 positive specimens collected 7 d apart; his next specimen, collected 15 d later, was negative.
§Oseltamivir dosing varied from HD at 150 mg 2×/d to SD at 75 mg 2×/d.

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