2798. Respiratory Viral Infections in Patients with Lymphoma and Multiple Myeloma: Risk Factors Associated with Progression to Lower Respiratory Tract Infection and Mortality

Abstract

Abstract Background Respiratory viral infections (RVIs) commonly infect immunocompromised patients, and may cause increased morbidity and mortality. However, data on lymphoma and multiple myeloma (MM) patients with RVIs is scarce. The objectives of our study were to identify risk factors for progression to lower respiratory tract infection (LRTI) and fatal outcome in this patient population with RVIs. Methods All lymphoma or MM patients at our center who were diagnosed with either influenza, respiratory syncytial virus (RSV), parainfluenza virus (PIV) or human metapneumovirus (hMPV) from January 2016 and July 2018 were included in our study. All demographics and clinical data were collected from electronic medical records retrospectively. Patients were classified as having an upper respiratory tract infection (URTI) if nasal wash was positive for the respiratory virus with no radiological evidence of lower respiratory tract involvement. Patients were deemed with lower respiratory tract infection (LRTI) if nasal wash was positive for the respiratory virus and with new or progressive infiltrates on chest imaging with (proven LRTI) or without (probable LRTI) microbiological evidence of the respiratory virus in the lower airways. Results A total of 353 patients were included in our study; of those 207 (59%) were MM patients. Most patients were on active chemotherapy (317, 90%) and steroids (242, 69%) at the time of diagnosis. Majority of the patients were infected with PIV and influenza (figure). A total of 150 (43%) patients had an LRTI, of those 36 (24%) were proven. Mortality was 12% (n = 18) within 30 days of onset of infection. Diagnosis of MM, active disease, the use of steroids (regardless of dose), prior stem cell transplantation, nosocomial infection and lymphopenia ≤ 200 cells/mL were significantly associated with LRTI (table). Conclusion Although mortality from these different viruses was uncommon, the proportion of patient with LRTI was high. Several risk factors for LRTI were identified. These findings may help us identify patients at high-risk for worse outcomes and who may benefit from antiviral therapies. Disclosures Roy F. Chemaly, MD, MPH, FACP, FIDSA, Chimerix: Advisory Board, Research Grant; Clinigen: Advisory Board; Merck: Advisory Board, Consultant, Grant/Research Support, Research Grant, Speaker’s Bureau; Oxford immunotec: Consultant, Grant/Research Support; Shire: Research Grant, Speaker’s Bureau; Viracor: Grant/Research Support.