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 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.