Clinical Scorecard: Assessment of Outcomes and Contributing Factors for Lower Respiratory Tract Infections and Mortality Associated with Influenza and Respiratory Syncytial Virus in Patients Diagnosed with Lymphoma or Multiple Myeloma: A 7-Year Retrospective Analysis

At a Glance

Key Highlights

• RSV infection, smoking history, steroid exposure, lymphopenia, and elevated serum creatinine are associated with increased risk of lower respiratory tract infection (LRI).
• Multiple myeloma diagnosis, smoking history, lymphopenia, and nosocomial infection are linked to higher 30-day mortality.
• LRI, smoking history, and lymphopenia are significant predictors of 90-day mortality in this patient population.

Guideline-Based Recommendations

Diagnosis

• Use BioFire Film Array Respiratory Panel 2.1 PCR testing on nasal washes or swabs for detection of RSV or influenza virus in symptomatic patients.
• Classify infections as upper respiratory tract infection (URI) or lower respiratory tract infection (LRI) based on clinical symptoms and radiologic evidence.
• Identify nosocomial infections if onset occurs >48 hours after admission for influenza or >5 days for RSV.

Management

• Early identification of high-risk patients based on risk factors (e.g., lymphopenia, steroid exposure, smoking history) to guide prompt treatment.
• Monitor patients closely for progression from URI to LRI to enable timely intervention.
• Consider hospitalization and intensive care support for patients with LRI or severe symptoms.

Monitoring & Follow-up

• Regular assessment of lymphocyte counts and renal function (serum creatinine) during infection course.
• Close follow-up for 30- and 90-day mortality outcomes.
• Monitor for respiratory deterioration requiring oxygen or mechanical ventilation.

Risks

• Current or former smoking increases risk of LRI and mortality.
• Lymphopenia (≤200 cells/mL) is a strong predictor of LRI and mortality.
• Steroid exposure and elevated serum creatinine contribute to worse respiratory infection outcomes.
• Nosocomial acquisition of infection is associated with increased 30-day mortality.

Patient & Prescribing Data

Adults with lymphoma or multiple myeloma diagnosed with RSV or influenza virus infections

Identification of risk factors such as lymphopenia and steroid exposure can inform early and aggressive management to prevent progression to LRI and reduce mortality.

Clinical Best Practices

• Perform timely respiratory viral testing in symptomatic lymphoma and multiple myeloma patients.
• Assess and document risk factors including smoking history, lymphocyte counts, steroid use, and renal function.
• Implement early supportive care and consider hospitalization for patients at high risk of LRI.
• Monitor patients closely for clinical deterioration and escalate care as needed.
• Recognize the importance of preventing nosocomial infections to reduce mortality.

References

• Respiratory viral infections in hematologic malignancies
• Risk factors for RSV and influenza in hematopoietic cell transplant recipients
• Outcomes of influenza and RSV infections in multiple myeloma