A multicenter study of pandemic influenza A (H1N1) infection in patients with solid tumors in 3 countries

Early therapy improves outcomes

Authors

  • Roy F. Chemaly MD, MPH,

    Corresponding author
    1. Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    • Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1460, Houston, TX 77030

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    • The first 2 authors contributed equally to this article.

    • Fax: (713) 745-6839

  • Karen J. Vigil MD,

    1. Division of Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, Texas
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    • The first 2 authors contributed equally to this article.

  • Mustafa Saad MD,

    1. Infection Control Program, King Hussein Cancer Center, Amman, Jordan
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  • Diana Vilar-Compte MD,

    1. Department of Infectious Diseases, National Cancer Institute, Federal District of Mexico, Mexico
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  • Patricia Cornejo-Juarez MD,

    1. Department of Infectious Diseases, National Cancer Institute, Federal District of Mexico, Mexico
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  • Carolina Perez-Jimenez MD,

    1. Department of Infectious Diseases, National Cancer Institute, Federal District of Mexico, Mexico
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  • Sawsan Mubarak RN,

    1. Infection Control Program, King Hussein Cancer Center, Amman, Jordan
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  • Mohammed Salhab MD,

    1. Infection Control Program, King Hussein Cancer Center, Amman, Jordan
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  • Ying Jiang MS,

    1. Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Bruno Granwehr MD,

    1. Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Javier A. Adachi MD,

    1. Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Issam I. Raad MD

    1. Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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Abstract

BACKGROUND:

Pandemic influenza A (hereafter 2009/H1N1) caused significant morbidity and mortality during the 2009 pandemia. Patients with chronic medical conditions and immunosuppressive diseases had a greater risk of complications. However, data regarding the characteristics and outcome of 2009/H1N1 infection in patients with solid tumors are nonexistent. Herein, the authors describe a series of influenza 2009/H1N1 in patients with solid malignancies at 3 major cancer hospitals worldwide.

METHODS:

The authors retrospectively reviewed the records of patients with solid organ malignancies and 2009/H1N1 from The University of Texas M. D. Anderson Cancer Center in Houston, Texas; the Mexican National Cancer Institute, Federal District of Mexico; and King Hussein Cancer Center in Amman, Jordan from the period of the 2009 H1N1 pandemia. Data on demographics, disease characteristics, and outcome were extracted.

RESULTS:

In total, 115 cases were identified during the pandemic influenza among the 3 institutions. High rates of hospitalization (50%), pneumonia (23%), and death (9.5%) were reported. Patients who developed pneumonia and those who died were moderately to severely immunocompromised (P = .001 and P = .006, respectively). A multivariate competing risk analysis demonstrated that a delay >48 hours in starting antiviral therapy was associated significantly with an increased risk of developing pneumonia (P = .013).

CONCLUSIONS:

The 2009/H1N1 pandemic caused severe illness in immunocompromised patients with cancer who had solid tumors, and heavily immunosuppressed patients were at greater risk of developing pneumonia and death. Early initiation of antiviral therapy is crucial in this patient population to decrease morbidity and probably mortality. Cancer 2012. © 2012 American Cancer Society.

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