Differences in clinical outcomes after 2009 influenza A/H1N1 and seasonal influenza among hematopoietic cell transplant recipients

被引:101
作者
Choi, Su-Mi [1 ,2 ]
Boudreault, Alexandre A. [1 ,3 ]
Xie, Hu [4 ]
Englund, Janet A. [5 ]
Corey, Lawrence [1 ,4 ,6 ,7 ]
Boeckh, Michael [1 ,4 ,7 ]
机构
[1] Fred Hutchinson Canc Res Ctr, Vaccine & Infect Dis Div, Seattle, WA 98109 USA
[2] Catholic Univ Korea, Dept Internal Med, Seoul, South Korea
[3] Hotel Dieu Quebec Hosp, Quebec City, PQ, Canada
[4] Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98109 USA
[5] Seattle Childrens Hosp & Res Inst, Seattle, WA USA
[6] Univ Washington, Dept Lab Med, Seattle, WA 98195 USA
[7] Univ Washington, Dept Med, Seattle, WA USA
基金
美国国家卫生研究院;
关键词
RESPIRATORY VIRUS-INFECTIONS; ORAL BECLOMETHASONE DIPROPIONATE; STEM-CELL; H1N1; INFLUENZA; ANTIVIRAL AGENTS; PANDEMIC H1N1; RISK-FACTORS; TRANSMISSION; PATHOGENESIS; OSELTAMIVIR;
D O I
10.1182/blood-2010-11-319186
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
It is not known whether pandemic 2009 influenza A/H1N1 (2009 H1N1) leads to more serious disease than seasonal influenza in hematopoietic cell transplant (HCT) recipients. In a retrospective study in HCT recipients with virologically proven influenza virus infection, a total of 161 HCT recipients (18 2009 H1N1, 103 seasonal influenza A, and 40 seasonal influenza B) were analyzed. In multivariable analyses, more patients with 2009 H1N1 had lower respiratory tract disease (LRD), hypoxemia, and prolonged viral shedding compared with seasonal influenza A. Seasonal influenza A and B outcomes were similar. There was no difference in overall and influenza-associated mortality among influenza virus types. Both early and delayed administration of antiviral therapy was shown to be beneficial in terms of decreased rates of development of LRD, although earlier intervention appeared to be more effective. Profound lymphopenia and lack of early antiviral therapy were associated significantly with LRD, hypoxemia, and death. High-dose corticosteroid treatment (>= 1 mg/kg) given at the time of influenza diagnosis was associated with a reduced risk for mechanical ventilation. Thus, our data suggest that infection with 2009 influenza A/H1N1 resulted in more severe respiratory disease in HCT recipients compared with seasonal influenza. (Blood. 2011; 117(19): 5050-5056)
引用
收藏
页码:5050 / 5056
页数:7
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