Session: 723. Clinical Allogeneic and Autologous Transplantation: Late Complications and Approaches to Disease Recurrence: Poster III
Hematology Disease Topics & Pathways:
viral, Adult, Diseases, Infectious Diseases, Study Population, Clinically relevant
Methods: We reviewed patient demographics, oncology and transplant history from HSCT recipients with polymerase chain reaction (PCR)-confirmed influenza over 5 influenza seasons (from 2013-2014 through 2018-2019). Influenza subtype (A H1, H3, and B), laboratory studies at diagnosis, treatments, vaccination status, and outcomes for each influenza infection were recorded and analyzed.
Results: A total of 143 infection events were collected and analyzed for symptoms and outcomes. Influenza infections of each subtype occurred in each season, although a different strain predominated each season. The most common symptoms at presentation were cough (65.3%) and fever (55.2%). Symptoms at presentation and outcomes were not significantly different amongst Influenza type A H1, A H3 and type B infections (p>0.05). In total, 22 (15.4%) infections presented as lower respiratory tract infections (LRTIs) and 7 additional infections progressed to LRTIs (all LRTI: 29; 20.1%). 63 (44.1%) infected patients required hospital admission, 15 (10.5%) required transfer to the intensive care unit (ICU) and 8 (5.6%) were intubated. 6 patients (4.2%) died by 30 days after the initial positive test, and 23 (16.1%) died by 180 days. LRTI was significantly associated with hospital admission (p<0.001), transfer to the ICU (p<0.001), intubation (p=0.005), and 30-day mortality (p=0.016); it was not significantly associated with 180-day mortality (0.357). The chronic use of steroids within the past 30 days prior to the initial positive test was significantly associated with risk of presenting with a LRTI (p=0.009), all LRTI (p=0.017), admission (p=0.010), and both 30-day (p=0.027) and 180-day mortality (p=0.016). It was not significantly associated with transfer to the ICU (p>0.05) or intubation (p>0.05). No other factors were significantly associated with LRTI, including vaccination status or treatment with antivirals (p>0.05). Logistic regression analysis of selected factors found that patients receiving steroids were significantly associated with LRTI (OR 2.58: 95% CI 1.00-6.63; p=0.047) (Table 1). There was, however, no statistically significant association detected between active graft-versus-host disease and LRTI (OR 1.25: 95% CI 0.35-4.06; p=0.721). We also found that treatment with oseltamivir within 2 days of symptom onset was not significantly associated with LRTI (OR 1.42: 95% CI 0.59-3.49; p=0.431). Persistent shedding (positive tests longer than 21 days from initial positive test) was also not associated with adverse outcomes (p>0.05).
Conclusion: This study suggests that the use of chronic steroids in treatment for graft-versus-host disease in HSCT patients may increase the risk for adverse outcomes in influenza infections.
Disclosures: No relevant conflicts of interest to declare.
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