Clinical Report: Respiratory Viral Infections in Hematologic Cancer Patients
Overview
This multicenter retrospective cohort study evaluated 385 hospitalizations of patients with hematologic malignancies or hematopoietic stem cell transplants admitted for acute respiratory viral infections. The study found similar mortality or hospice discharge rates across different viral pathogens, with SARS-CoV-2 infections showing higher lung edema scores and distinct care patterns such as increased corticosteroid use.
Background
Patients with hematologic malignancies or hematopoietic cell transplants (HCT) are at high risk for severe respiratory viral infections, which contribute significantly to morbidity and mortality. Prior studies have often focused on single pathogens or specific populations, limiting understanding of pathogen-specific clinical courses in this vulnerable group. Given the rising incidence of hematologic cancers, characterizing these infections is critical for improving patient management. This study aimed to compare clinical presentations, treatment approaches, and outcomes across respiratory viruses in hospitalized patients with hematologic malignancies or HCT.
Data Highlights
Pathogen
Hospitalizations (n)
Death or Hospice (%)
Median Lung Edema Score (IQR)
Antibiotic Use (%)
Corticosteroid Use ≥40 mg Prednisone Equiv. (%)
SARS-CoV-2
162
Not significantly different (P=0.4)
28 (22–32)
60%
61%
Respiratory Syncytial Virus (RSV)
28
Not significantly different (P=0.4)
5 (2–9)
61%
36%
Rhino/Enterovirus
91
Not significantly different (P=0.4)
5 (2–9)
65%
33%
Influenza
33
Not significantly different (P=0.4)
5 (2–9)
67%
27%
Other Viruses
86
Not significantly different (P=0.4)
5 (2–9)
80%
43%
Key Findings
The composite outcome of hospital death or discharge to hospice occurred in 14% of hospitalizations and did not differ significantly across viral pathogens (P = .4).
SARS-CoV-2 infections were associated with significantly higher radiographic lung edema scores compared to other respiratory viruses (median 28 vs 5, P < .001).
Antibiotic use varied by pathogen, with the highest use in infections from other viruses (80%) and lowest in SARS-CoV-2 (60%) (P = .034).
Corticosteroid use at doses ≥40 mg prednisone equivalents daily was most frequent in SARS-CoV-2 infections (61%) compared to other viruses (27%–43%) (P < .001).
Despite differences in care processes and lung edema severity, initial respiratory physiology and overall outcomes were similar across viral pathogens in this patient population.
Clinical Implications
Clinicians should recognize that respiratory viral infections in patients with hematologic malignancies or HCTs carry a similar risk of mortality or hospice discharge regardless of the viral pathogen. The higher lung edema burden and corticosteroid use in SARS-CoV-2 infections may guide tailored supportive care and therapeutic decisions. Awareness of these pathogen-specific differences can inform antibiotic stewardship and corticosteroid prescribing practices in this vulnerable population.
Conclusion
Among hospitalized patients with hematologic malignancies or HCTs, acute respiratory viral infections demonstrate comparable mortality outcomes despite pathogen-specific differences in lung edema severity and treatment approaches. These findings support a nuanced, pathogen-informed clinical management strategy.
References
Leisman et al. 2024 -- Patient Profiles and Outcomes of Those With Hematologic Cancers Admitted Due to Respiratory Viral Infections
by Zulfiqar A Lokhandwala, Brenna Park-Egan, Ravneet Waraich, Colleen A McEvoy, Andrew P Michelson, Alice F Bewley, Lynne Strasfeld, Rachel Cook, Brandon Hayes-Lattin, Catherine L Hough, Patrick G Lyons
