Characteristics and Outcomes of Patients With Hematologic Malignancies Hospitalized With Respiratory Viral Infections

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Abstract Background Respiratory viral infections in patients with hematologic malignancies or hematopoietic stem cell transplants (HCTs) are associated with increased morbidity and mortality. However, the hospital presentations and courses of these infections remain under-described. Methods We performed a multicenter retrospective cohort study of hospitalized patients with hematologic malignancy or HCT at 2 comprehensive cancer centers between January 2019 and June 2023. We included all patients with acute viral respiratory infection (identified based on a constellation of test results and objective physiology), comparing clinical presentations, care processes, and patient outcomes across pathogens; the primary outcome was the composite of hospital death or discharge to hospice. Results We evaluated 385 hospitalizations from 346 unique patients, 162 (42%) of which were for SARS-CoV-2 infection. The primary outcome of death or discharge to hospice occurred in 54 (14%) encounters and did not significantly differ across pathogens (P = .4). We observed higher radiographic assessment of lung edema scores in SARS-CoV-2 infection (median 28 [interquartile range 22–32]) compared with other viral infections (5 [2–9], P < .001). Care process differences across pathogens included antibiotic (SARS-CoV-2 98/162 [60%], respiratory syncytial virus [RSV] 17/28 [61%], rhino/enterovirus 59/91 [65%], influenza 22/33 [67%], and others 69/86 [80%], P = .034) and corticosteroid use (≥ 40 mg prednisone equivalents daily: SARS-CoV-2 99/162 [61%], RSV 10/28 [36%], rhino/enterovirus 30/91 [33%], influenza 9/33 [27%], and others 37/86 [43%], P < .001). Interpretation Among hospitalized patients with hematologic malignancies or HCTs, acute viral respiratory infections display similar initial physiology and outcomes regardless of pathogen. These findings may have implications for clinical practice.

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