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Community-acquired respiratory infections are common in patients with non-Hodgkin lymphoma and multiple myeloma

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Abstract

Purpose

Available data suggest that respiratory infections are associated with increased morbidity and mortality in patients hospitalized due to acute leukemia and allogeneic stem cell transplantation (allo-SCT). However, the precise incidence, risk factors, and severity of respiratory infection, mainly community-acquired, in patients with lymphoma and multiple myeloma (MM) are not fully determined. The current study aimed to investigate risk factors for respiratory infections and their clinical significance in patients with B cell non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) in the first year of diagnosis.

Methods

Data of consecutive patients diagnosed with NHL or MM and treated at the Rambam Hematology Inpatient and Outpatient Units between 01/2011 and 03/2012 were evaluated. Information regarding anticancer treatment, incidence and course of respiratory infections, and infection-related outcomes was analyzed.

Results

One hundred and sixty episodes of respiratory infections were recorded in 103 (49%) of 211 (73-MM, 138-NHL) patients; 126 (79%) episodes were community-acquired, 47 (29%) of them required hospitalization. In univariate analysis, age < 60 years, MM diagnosis, and autologous SCT increased the respiratory infection risk (P = 0.058, 0.038, and 0.001, respectively). Ninety episodes (56% of all respiratory episodes) were examined for viral pathogens. Viral infections were documented in 25/90 (28%) episodes, 21 (84%) of them were community-acquired, requiring hospitalization in 5 (24%) cases. Anti-flu vaccination was performed in 119 (56%) patients. Two of the six patients diagnosed with influenza were vaccinated.

Conclusions

Respiratory infections, including viral ones, are common in NHL and MM. Most infections are community-acquired and have a favorable outcome. Rapid identification of viral pathogens allows avoiding antibiotic overuse in this patient population.

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References

  1. Maschmeyer G, Donnelly JP (2016) How to manage lung infiltrates in adults suffering from haematological malignancies outside allogeneic haematopoietic stem cell transplantation. Br J Haematol 173(2):179–189. https://doi.org/10.1111/bjh.13934

    Article  PubMed  CAS  Google Scholar 

  2. Maschmeyer G, Carratala J, Buchheidt D, Hamprecht A, Heussel CP, Kahl C, Lorenz J, Neumann S, Rieger C, Ruhnke M, Salwender H, Schmidt-Hieber M, Azoulay E (2015) Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients (allogeneic SCT excluded): updated guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Oncol 26(1):21–33. https://doi.org/10.1093/annonc/mdu192

    Article  PubMed  CAS  Google Scholar 

  3. Cheuk DK, Chiang AK, Lee TL, Chan GC, Ha SY (2011) Vaccines for prophylaxis of viral infections in patients with hematological malignancies. Cochrane Database Syst Rev CD006505

  4. Hohenthal U, Nikoskelainen J, Vainionpaa R, Peltonen R, Routamaa M, Itala M, Kotilainen P (2001) Parainfluenza virus type 3 infections in a hematology unit. Bone Marrow Transplant 27(3):295–300. https://doi.org/10.1038/sj.bmt.1702776

    Article  PubMed  CAS  Google Scholar 

  5. Campbell AP, Chien JW, Kuypers J, Englund JA, Wald A, Guthrie KA, Corey L, Boeckh M (2010) Respiratory virus pneumonia after hematopoietic cell transplantation (HCT): associations between viral load in bronchoalveolar lavage samples, viral RNA detection in serum samples, and clinical outcomes of HCT. J Infect Dis 201(9):1404–1413. https://doi.org/10.1086/651662

    Article  PubMed  PubMed Central  Google Scholar 

  6. Khanna N, Widmer AF, Decker M, Steffen I, Halter J, Heim D, Weisser M, Gratwohl A, Fluckiger U, Hirsch HH (2008) Respiratory syncytial virus infection in patients with hematological diseases: single-center study and review of the literature. Clin Infect Dis 46(3):402–412. https://doi.org/10.1086/525263

    Article  PubMed  CAS  Google Scholar 

  7. Azoulay E (ed) (2011) Pulmonary involvement in patients with hematological malignancies. Springer Verlag, Heidelberg. https://doi.org/10.1007/978-3-642-15742-4

    Book  Google Scholar 

  8. Mahony JB (2010) Nucleic acid amplification-based diagnosis of respiratory virus infections. Expert Rev Anti-Infect Ther 8(11):1273–1292. https://doi.org/10.1586/eri.10.121

    Article  PubMed  CAS  Google Scholar 

  9. Carman WF, Wallace LA, Walker J, McIntyre S, Noone A, Christie P, Millar J, Douglas JD (2000) Rapid virological surveillance of community influenza infection in general practice. BMJ 321(7263):736–737. https://doi.org/10.1136/bmj.321.7263.736

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Hirsch HH, Martino R, Ward KN, Boeckh M, Einsele H, Ljungman P (2013) Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis and treatment of human respiratory syncytial virus, parainfluenza virus, metapneumovirus, rhinovirus, and coronavirus. Clin Infect Dis 56(2):258–266. https://doi.org/10.1093/cid/cis844

    Article  PubMed  Google Scholar 

  11. Friman V, Winqvist O, Blimark C, Langerbeins P, Chapel H, Dhalla F (2016) Secondary immunodeficiency in lymphoproliferative malignancies. Hematol Oncol 34(3):121–132. https://doi.org/10.1002/hon.2323

    Article  PubMed  Google Scholar 

  12. Griffiths H, Brennan V, Lea J, Bunch C, Lee M, Chapel H (1989) Crossover study of immunoglobulin replacement therapy in patients with low-grade B-cell tumors. Blood 73(2):366–368

    PubMed  CAS  Google Scholar 

  13. Englund J, Feuchtinger T, Ljungman P (2011) Viral infections in immunocompromised patients. Biol Blood Marrow Transplant 17(1):S2–S5. https://doi.org/10.1016/j.bbmt.2010.11.008

    Article  PubMed  PubMed Central  Google Scholar 

  14. Arola M, Ruuskanen O, Ziegler T, Salmi TT (1995) Respiratory virus infections during anticancer treatment in children. Pediatr Infect Dis J 14(8):690–694. https://doi.org/10.1097/00006454-199508000-00008

    Article  PubMed  CAS  Google Scholar 

  15. Koskenvuo M, Mottonen M, Rahiala J, Saarinen-Pihkala UM, Riikonen P, Waris M, Ziegler T, Uhari M, Salmi TT, Ruuskanen O (2008) Respiratory viral infections in children with leukemia. Pediatr Infect Dis J 27(11):974–980. https://doi.org/10.1097/INF.0b013e31817b0799

    Article  PubMed  Google Scholar 

  16. Ohrmalm L, Wong M, Aust C, Ljungman P, Norbeck O, Broliden K, Tolfvenstam T (2012) Viral findings in adult hematological patients with neutropenia. PLoS One 7(5):e36543. https://doi.org/10.1371/journal.pone.0036543

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Mikulska M, Del Bono V, Gandolfo N, Dini S, Dominietto A, Di Grazia C, Bregante S, Varaldo R, Orsi A, Ansaldi F, Bacigalupo A, Viscoli C (2014) Epidemiology of viral respiratory tract infections in an outpatient haematology facility. Ann Hematol 93(4):669–676. https://doi.org/10.1007/s00277-013-1912-0

    Article  PubMed  Google Scholar 

  18. Teh BW, Worth LJ, Harrison SJ, Thursky KA, Slavin MA (2015) Risks and burden of viral respiratory tract infections in patients with multiple myeloma in the era of immunomodulatory drugs and bortezomib: experience at an Australian Cancer Hospital. Support Care Cancer 23(7):1901–1906. https://doi.org/10.1007/s00520-014-2550-3

    Article  PubMed  Google Scholar 

  19. Kelesidis T, Daikos G, Boumpas D, Tsiodras S (2011) Does rituximab increase the incidence of infectious complications? A narrative review. Int J Infect Dis 15(1):e2–16. https://doi.org/10.1016/j.ijid.2010.03.025

    Article  PubMed  CAS  Google Scholar 

  20. Kainulainen L, Vuorinen T, Rantakokko-Jalava K, Osterback R, Ruuskanen O (2010) Recurrent and persistent respiratory tract viral infections in patients with primary hypogammaglobulinemia. J Allergy Clin Immunol 126(1):120–126. https://doi.org/10.1016/j.jaci.2010.04.016

    Article  PubMed  Google Scholar 

  21. Eliakim-Raz N, Vinograd I, Zalmanovici Trestioreanu A, Leibovici L, Paul M (2013) Influenza vaccines in immunosuppressed adults with cancer. Cochrane Database Syst Rev CD008983

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Acknowledgements

The authors would like to thank Sonia Kamenetsky for the preparation of this manuscript.

Author information

Author notes

  1. Noa Lavi and Irit Avivi contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

    Noa Lavi

  2. Department of Hematology and Bone Marrow Transplantation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Irit Avivi

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Irit Avivi

  4. Virology Laboratory, Rambam Health Care Campus, Haifa, Israel

    Zipora Kra-Oz

  5. Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel

    Zipora Kra-Oz, Ilana Oren & Emilia Hardak

  6. Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel

    Ilana Oren

  7. Division of Pulmonary Medicine, Rambam Health Care Campus, 8, Ha’Aliya St., 31096, Haifa, Israel

    Emilia Hardak

Authors
  1. Noa Lavi
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  2. Irit Avivi
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  3. Zipora Kra-Oz
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  4. Ilana Oren
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  5. Emilia Hardak
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Corresponding author

Correspondence to Emilia Hardak.

Ethics declarations

The current retrospective study was approved by the Institutional Review Board of the Rambam Health Care Campus in Haifa, Israel (approval no. 0229-13).

Conflict of interest

The authors declare that they have no conflicts of interest.

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Lavi, N., Avivi, I., Kra-Oz, Z. et al. Community-acquired respiratory infections are common in patients with non-Hodgkin lymphoma and multiple myeloma. Support Care Cancer 26, 2425–2431 (2018). https://doi.org/10.1007/s00520-018-4079-3

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  • DOI: https://doi.org/10.1007/s00520-018-4079-3

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