Comparison of clinical features and outcomes in haematopoietic cell transplant recipients infected with 2009 pandemic H1N1 in64258; uenza A and seasonal in64258; uenza A virus

Ref ID: 18606

Author:

S. Dadwal, J Kriengkauykiat, F. Cooper, B. Tegtmeier,
S. Forman, J. Ito

Author address:

City of Hope (Duarte, US)

Full conference title:

Annual Meeting of the EBMT, 37th

Abstract:

Objective: Compare outcomes/ clinical features of 2009
pandemic H1N1 infl uenza A (PIA) versus (vs.) seasonal infl uenza A (SIA) virus infection in hematopoietic cell transplant
(HCT) recipients.
Methods: Medical records of patients with infl uenza like illness
and positive test for SIA between 10/2005 and 3/2009 (INF
season between October and March) and PIA between 4/2009
and 12/2009 were reviewed for demographics, HCT type, conditioning regimen, graft versus host disease (GvHD), steroid
use, clinical features, microbiology, antiviral therapy, and survival amongst PIA versus SIA.
Results: 2557 HCT (1213 allogenic and 1344 autologous)
performed between 2005 and 2009. 29 PIA and 24 SIA cases
identifi ed with comparison as follows: No difference in age and
sex distribution; Allogenic HCT in 23/29 vs. 22/24 (p=0.27),
rest autologous; Myeloablative conditioning 9/29 vs. 14/24
(p=0.10); GvHD 12/23 and 8/22 respectively (p=1.00); 11/29
and 14/24 were on steroids (p=0.42); 13/26 and 13/21 had lymphopenia (p=0.56). Microbiology: All PIA had polymerase chain
reaction (PCR) +; direct fl ouroscent antigen (DFA) + in 2/12
vs. 15/20 (p=0.003); and culture + in 24/25 vs.13/24, in those
tested (p=0.0008). No difference noted in fever, chills, cough,
gastrointestinal symptoms, myalgias and hospitalization; Upper
respiratory infection (URI) in 22/29 vs. 11/25 (p=0.03), and lower
respiratory tract infection (LRTI) in 7/29 vs. 12/24 (p=0.08).
Amongst LRTI: 6/7 had allogenic HCT vs. 10/12 (p 1.00); 4/7 vs.
5/12 required intubation (p=0.65) and 3/7 vs. 6/12 died (p=1.00);
Fungal co-infection in 3/29 (all 3 pulmonary aspergillosis) vs.
2/24 (1 pulmonary aspergillosis, 1 candidemia) (p=0.15). 24/29
vs. 19/24 received antivirals (oseltamivir or zanamivir with or
without adamantanes) (p=1.0). 4/29 vs. 6/24 had died at 100
days after diagnosis (p=0.48). No deaths in autologous HCT
(p=0.33). 1/5 vs. 0/5 untreated patients died. 2 of 4 deaths in
PIA had coinfection with aspergillus, and 1 infected with oseltamivir resistant strain (H275Y mutation+); 2 of 6 deaths in SIA
had fungal infection and 1 had respiratory syncitial virus (RSV)
infection. GvHD did not correlate with excess mortality or LRTI
in either group. Decreased survival was associated with steroid
use in PIA (p=0.04). Kaplan Meier survival curve demonstrated
trend towards higher survival in PIA (p=0.32).
Conclusion: Mortality is high in both groups with LRTI, without
signifi cant difference in outcomes between PIA and SIA.

Abstract Number: O197

Conference Year: 2011

Link to conference website: NULL

New link: NULL

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