P-635. Clinical Impact and Comparative Outcomes of hMPV and RSV Infections in Hematological Malignancy Patients: A Multinational Cohort Study

TL;DR

This study compares the clinical impact of hMPV and RSV infections in patients with hematological malignancies, finding high hospitalization and mortality rates similar to influenza and SARS-CoV-2.

Contribution

The study provides the first multinational comparison of hMPV and RSV outcomes in hematological malignancy patients, highlighting their significant clinical burden.

Findings

hMPV and RSV infections in hematological malignancy patients had high hospitalization rates (63.8% and 74.9%) and 30-day mortality (10.0% and 12.8%).

Compared to influenza and SARS-CoV-2, hMPV and RSV showed similar or higher rates of severe disease and hospitalization but less antiviral use.

RSV was associated with more pulmonary symptoms and bacterial co-infections than influenza and SARS-CoV-2.

Abstract

Respiratory viruses cause major morbidity and mortality in hematologic malignancies. While influenza and SARS-CoV-2 are well-characterized, data on hMPV and RSV remain scarce. We compared their clinical features in this high-risk group.

We conducted a multinational study of 130 hMPV and 243 RSV cases (2023–2024), with matched influenza and SARS-CoV-2 cohorts. Data covered patient characteristics, treatment, costs, and 30-day mortality.

The hMPV and RSV groups had similar demographics and disease profiles, mainly lymphoma and plasma cell disorders. Most infections occurred in winter, with >60% presenting with non-pulmonary symptoms. Severe disease occurred in 52.3% (hMPV) and 63.8% (RSV). Hospitalization rates were high (63.8% vs. 74.9%), ICU admissions similar (18.5% vs. 8.6%), and 30-day mortality was 10.0% (hMPV) vs. 12.8% (RSV).

Compared to hMPV, influenza cases had higher costs (US $33,250 vs. $18,517; p=0.034), greater antiviral use (74.1% vs. 1.9%; p< 0.001), and fewer bacterial co-infections (9.3% vs. 27.8%; p=0.024). SARS-CoV-2 cases also had more antivirals (65.1% vs. 1.2%; p< 0.001), fewer bacterial co-infections (9.3% vs. 25.6%; p=0.008), but slightly less severe disease (44.2% vs. 47.7%; p=0.003).

RSV was linked to more secondary infections than influenza (bacterial 21.3% vs. 12.4%, p=0.033; viral 5.6% vs. 1.1%, p=0.035), higher ward costs, and shorter intermediate care stays (5 vs. 12 days; p=0.010). Influenza patients were more often vaccinated (11.2% vs. 0.6%; p< 0.001) and treated with antivirals (82.0% vs. 15.2%; p< 0.001).

RSV showed more pulmonary symptoms (33.0% vs. 19.2%; p< 0.001), severe cases (62.1% vs. 40.4%; p< 0.001), and hospitalizations (74.4% vs. 54.2%; p< 0.001) than SARS-CoV-2, which had higher intermediate care costs and more targeted therapy (68.5% vs. 14.3%; p< 0.001).

hMPV and RSV had comparable clinical profiles and outcomes, though hMPV showed slightly less treatment and more bacterial co-infections.

In hematologic malignancy patients, hMPV and RSV cause substantial morbidity, high hospitalization and ICU rates, and 30-day mortality (10.0% and 12.8%), comparable to influenza and SARS-CoV-2. Yet, they remain under-treated, highlighting the need for improved diagnostics and targeted care.

Jon Salmanton-Garcia, MSc, MPH, PhD, menarini, gilead, astrazeneca, pfizer: Honoraria Oliver A. Cornely, Prof. Dr., Al-Jazeera Pharmaceuticals/Hikma: Honoraria|Basilea: Advisor/Consultant|Cidara: Advisor/Consultant|Cidara: Board Member|Cidara: Grant/Research Support|Elion: Advisor/Consultant|F2G: Grant/Research Support|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Honoraria|Grupo Biotoscana/United Medical/Knight: Honoraria|Melinta: Advisor/Consultant|Melinta: Board Member|MSD: Honoraria|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Mundipharma: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Pulmocide: Board Member|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria