Clinical Scorecard: Patient Profiles and Outcomes of Those With Hematologic Cancers Admitted Due to Respiratory Viral Infections
At a Glance
Category
Detail
Condition
Acute respiratory viral infections in patients with hematologic malignancies or hematopoietic stem cell transplants (HCTs)
Key Mechanisms
Respiratory viral infections cause increased morbidity and mortality through respiratory failure and lung injury; host immunocompromise due to malignancy and treatment influences infection severity
Target Population
Hospitalized adult patients with hematologic malignancies or prior hematopoietic stem cell transplant experiencing acute respiratory viral infection
Care Setting
Academic hospitals with National Cancer Institute-designated Comprehensive Cancer Centers
Key Highlights
Among 385 hospitalizations in 346 patients, 42% were due to SARS-CoV-2 infection; overall hospital death or discharge to hospice occurred in 14% of encounters.
No significant difference in primary outcome (death or hospice discharge) was observed across different respiratory viral pathogens.
SARS-CoV-2 infections showed higher radiographic lung edema scores and higher corticosteroid use compared to other viral infections.
Guideline-Based Recommendations
Diagnosis
Confirm respiratory viral infection by positive PCR or antigen test within ±7 days of admission.
Include patients with physiologically significant respiratory infection defined by respiratory rate >20, oxygen saturation <93%, or new use of supplemental/advanced respiratory support.
Management
Consider corticosteroid therapy, noting higher use in SARS-CoV-2 infections (≥40 mg prednisone equivalents daily).
Antibiotic use varies by pathogen but is common; clinical judgment required to guide antimicrobial therapy.
Monitoring & Follow-up
Monitor respiratory parameters including oxygen saturation and respiratory rate closely.
Use radiographic assessment to evaluate lung edema severity, especially in SARS-CoV-2 infections.
Risks
Patients with hematologic malignancies or HCT are at increased risk of morbidity and mortality from respiratory viral infections regardless of pathogen.
Immunocompromised status due to malignancy and therapy contributes to infection severity.
Patient & Prescribing Data
Hospitalized adults with hematologic malignancies or HCT and acute respiratory viral infection
Corticosteroids were used more frequently and at higher doses in SARS-CoV-2 infections compared to other viruses; antibiotic use was common but varied by pathogen.
Clinical Best Practices
Include comprehensive viral testing for respiratory pathogens in patients with hematologic malignancies presenting with respiratory symptoms.
Assess severity using objective respiratory parameters and radiographic imaging to guide management.
Tailor corticosteroid and antibiotic use based on pathogen and clinical presentation, recognizing similar outcomes across viral types.
Recognize that despite pathogen differences, initial physiology and outcomes are similar, supporting standardized supportive care approaches.
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
