Volume 16, Number 12—December 2010
CME ACTIVITY - Research
Pandemic (H1N1) 2009 Infection in Patients with Hematologic Malignancy
, Brian S. Schwartz, Snigdha Vallabhaneni, Michael Nixon, Peter V. Chin-Hong, Steven A. Miller, Charles Y. Chiu, Lloyd Damon, and W. Lawrence Drew
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.