Yöntem Yaman, Ilker Devrim, Yeşim Oymak, Ayşen Türedi, Gülcihan Ozek, Özgür Cartı, Meral Akçay Ciblak, Burçak Tatlı Güneş, Bengü Demirağ, Esin Albudak, Selim Badur, Canan Vergin
Division of Pediatric Hematology, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
Pediatr Hematol Oncol. 2013 Aug;30(5):437-44. doi: 10.3109/08880018.2013.796025. Epub 2013 May 22.
Pandemic influenza A/H1N1/2009 virus usually causes mild illness in healthy children. Chronic medical conditions are recognized as increasing the risk for complications of influenza virus infection. Although most studies including children with acute leukemia and H1N1 virus have reported no deaths, some anectodal reports with low patient numbers have reported mortality rates as high as 28.5%. Here, we report patients with leukemia and H1N1 virus and review the literature.
Medical records of all children with leukemia and H1N1 virus in our institution were reviewed for demographic, clinical, and laboratory data. We also carried out a systematic review of the English-language literature. Among the 24 articles found, only patients with leukemia and pandemic H1N1 infections were reviewed by two independent reviewers.
Eight of 98 children who received chemotherapy for leukemia were diagnosed with pandemic H1N1 infection. One developed pneumonia and acute respiratory distress syndrome (ARDS) and died. Another one developed hemophagocytic lymphohistiocytosis (HLH) and died due to secondary infection during the 6th week of treatment for HLH. In our study, 2 of 8 patients had a fatal course (25%), compared with an overall mortality of 2.5% in the studies retrieved from PubMed (6/232).
Pandemic H1N1 influenza virus caused mortality in patients with ARDS or HLH; an unexpected finding for pandemic H1N1 (2009) influenza virus. Thus, for children with leukemia and infected with H1N1 virus, short- and long-term complications should be kept in mind during evaluation.
2009年甲型H1N1大流行性流感病毒通常在健康儿童中引起轻症。慢性疾病被认为会增加流感病毒感染并发症的风险。尽管大多数纳入急性白血病患儿和H1N1病毒的研究报告无死亡病例，但一些病例数较少的个案报告称死亡率高达28.5%。在此，我们报告白血病合并H1N1病毒感染的患者并复习相关文献。
回顾了本院所有白血病合并H1N1病毒感染儿童的病历，以获取人口统计学、临床和实验室数据。我们还对英文文献进行了系统综述。在检索到的24篇文章中，仅由两名独立审阅者对白血病合并甲型H1N1大流行感染的患者进行了综述。
98名接受白血病化疗的儿童中有8名被诊断为甲型H1N1大流行感染。1例发生肺炎和急性呼吸窘迫综合征（ARDS）并死亡。另1例发生噬血细胞性淋巴组织细胞增生症（HLH），并在HLH治疗第6周时因继发感染死亡。在我们的研究中，8例患者中有2例病程呈致死性（25%），相比之下，从PubMed检索到的研究中总体死亡率为2.5%（232例中有6例）。
甲型H1N1大流行性流感病毒导致ARDS或HLH患者死亡；这是甲型H1N1（2009）大流行性流感病毒一个意外的发现。因此，对于感染H1N1病毒的白血病患儿，评估时应牢记短期和长期并发症。
