2009 H1N1 influenza infection in cancer patients and hematopoietic stem cell transplant recipients☆

Summary 

Objectives

Although usually mild, 2009 H1N1 Influenza has caused up to 6000 deaths in the US. To determine outcome in patients with cancer and/or hematopoietic stem cell transplant (HSCT), we reviewed our recent experience at Memorial Sloan-Kettering Cancer Center (MSKCC).

Methods

During the initial NYC outbreak (May 19–June 30, 2009), all respiratory samples at MSKCC were tested for 2009 H1N1 influenza by DFA, culture, and RT-PCR. Medical records were reviewed for all cases.

Results

During the 6-week period, 45(11%) of 394 tested patients were diagnosed with 2009 H1N1 Influenza. These included 29(17%) of 167 patients with hematologic conditions compared to 16(7%) of 226 with solid tumors (P < 0.01). 21(22%) of 96 tested HSCT recipients were positive. Cough (93%) and fever (91%) were common. Of 29 patients who were radiographically assessed, 8(27%) had lower airway disease. 17(37%) were hospitalized. None required mechanical ventilation. No deaths were attributed to influenza. All treated patients tolerated antiviral medication.

Conclusions

2009 H1N1 Influenza caused mild symptoms in most patients with cancer and/or HSCT. None died or required mechanical ventilation. Immunosuppression from cancer or its treatment including HSCT may not be a substantial risk for poor outcome, however further studies are needed to validate our results.

The consequences of 2009 H1N1 influenza infection among cancer patients and stem cell recipients are unknown. We describe 45 patients with cancer and/or hematologic conditions with 2009 H1N1 influenza, including 21 stem cell transplant recipients. None of the infections resulted in death or severe morbidity.

Keywords: 2009, H1N1, Influenza, Cancer, Stem cell transplantation