Despite High Morbidity, Mortality Low With Human Metapneumovirus

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Patients with hematologic malignancies are three times more likely to develop a lower respiratory tract infection.
Patients with hematologic malignancies are three times more likely to develop a lower respiratory tract infection.

Although human metapneumovirus (hMPV) infections resulted in significant morbidity in patients with cancer, 30-day mortality rates remained low, a study published in the journal Cancer has shown.1

hMPV, an enveloped, nonsegmented, negative RNA-Paramyxoviridae virus, causes upper and lower respiratory tract infections in both healthy and immunocompromised patients of all ages. Studies evaluating the incidence and outcomes of patients with cancer infected with hMPV were limited by their small sample sizes. Therefore, researchers sought to identify clinical characteristics and evaluate outcomes of hMPV infections in patients with cancer who are immunocompromised.

For the study, investigators retrospectively analyzed data from 181 patients with laboratory-confirmed hMPV infection treated between April 2012 and May 2015. Of those, 50% had hematologic malignancies, 31% were hematopoietic cell transplantation (HCT) recipients, and 19% had solid tumors.

Ninety-two percent of patients developed a community-acquired infection and 67% presented with upper respiratory tract infections. Forty-three percent of patients developed lower respiratory tract infections, including 19 who progressed from an upper to a lower respiratory tract infection.

After adjusting for multiple variables, researchers found that patients with hematologic malignancies were 3 times more likely to develop a lower respiratory tract infection (odds ratio [OR], 3.11; 95% CI, 1.12-8.64; P = .029). Patients who developed an infection while in the hospital had about a 27 times higher risk for developing a lower respiratory tract infection (OR, 26.9; 95% CI, 2.79-259.75; P = .004).

Hypoxia at presentation increased the risk of a lower respiratory tract infection by nearly 10 times (OR, 9.61; 95% CI, 1.98-46.57; P = .005).

Despite causing lower respiratory tract infections in 43% of patients, 96% of the total population and 90% of those with lower respiratory infections were alive at 30 days. No patients with upper respiratory tract infections were dead from any cause at 30 days after diagnosis.

The findings ultimately that clinicians should closely monitor patients with hematologic malignancies, nosocomial infections, and hypoxia at presentation for risk of progression to a lower respiratory tract infection.

Reference

1. El Chaer F, Shah DP, Kmeid J, et al. Burden of human metapneumovirus infections in patients with cancer: Risk factors and outcomes. Cancer. 2017 Feb 8. doi: 10.1002/cncr.30599 [Epub ahead of print]

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