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Year : 2017  |  Volume : 10  |  Issue : 5  |  Page : 1354-1355
Swine fluand lymphoma: A short summary

1 Wiwanitkit House, Bangkhae, Bangkok, Thailand
2 Hainan Medical University, China

Click here for correspondence address and email

Date of Web Publication6-Nov-2017

How to cite this article:
Wiwanitkit S, Wiwanitkit V. Swine fluand lymphoma: A short summary. Ann Trop Med Public Health 2017;10:1354-5

How to cite this URL:
Wiwanitkit S, Wiwanitkit V. Swine fluand lymphoma: A short summary. Ann Trop Med Public Health [serial online] 2017 [cited 2020 Jul 15];10:1354-5. Available from:

Dear Editor,

There are many reports on swine flu in the patients with lymphoma as a pandemic disease.[1],[2] The first world report is in 2009 by Kidd et al.[4] who reported a case of severe pneumonitis in lymphoma patient who got swine flu.[4] In this case, zanamivir is effective for disease management.[4] Since 2009, many cases have been sporadically reported. Vandroux et al. reported a case and mentioned that swine flu could be an important nosocomial infection.[5]

They noted that it was important to find a proper preventive measure for any hospitalized lymphoma patients.[5]

As already noted, swine flu is a viral respiratory illness. The clinical manifestation of swine flu in patients with lymphoma is mainly a respiratory illness. However, as a cancerous patient, the symptoms is usually severe.[3]

Namendys-Silva et al. reported on “the variability of Rt-PCR test forH1N1” and mentioned the importance of clinical diagnosis.[6]

Also, Ñamendys-Silva et al. reported that an abnormal prolonged lymphocytopenia can be an important finding in the lymphoma patient with swine flu.[6] Rare complications such as hemophagocytic syndrome are also reported in lymphoma patients with swine flu.[7] Focusing on clinical course, more severe and prolonged diseases comparing to general patients could be seen.[3] Fever (>38.5°C), cough, and rhinorrhea are the first common symptoms [7] in which hospitalization is usually required.[7] For antiviral drug treatment, Oseltamivir is the standard drug [7] and Zanamivir is indicated in severe cases when Oseltamivir fails.[7] Minnema et al. reported that the mean duration of hospitalization and the duration of antiviral treatment were usually long.[8] They said that this observation possibly reflected “decreased clearance of the virus as a consequence of impaired immunity”.[8]

It is suggested that vaccination is the most effective tool for controlling influenza. A cancerous patient is the focused group for vaccination towards influenza.[9] An important problem in vaccination for a lymphoma patient towards swine flu is the poor immune response. Bedognetti et al. firstly reported on “impaired response to influenza vaccine associated with persistent memory B cell depletion in non-Hodgkin's lymphoma patients treated with rituximab-containing regimens”.[10] The similar observations were also reported by Monkman et al.[11] and Yri et al.[12] Hottinger et al. mentioned that B cell depletion due to rituximab was the reason of poor immunogenicity of vaccine.[13] Yri et al. concluded that “lymphoma patients receiving rituximab-containing regimens might'' not benefit from vaccination.[12] Villa et al. also found that using adjuvant or second dose booster did not help increase immunogenicity.[14]

In addition, Strowd et al. reported poorer immune response in the patients with CNS lymphoma.[15]

The problem is also observed in the lymphoma patients previously treated with rituximab containing regimensin complete remissionstage.[16] Nevertheless, Villa et al. still recommended for vaccination despite poor immunogenicity outcome.[14]

In conclusion, lymphoma patients with swine flu usually have a severe and prolonged infection. The practitioner is supposed to recognize and manage the disease early. Since vaccination in lymphoma patients receiving rituximab chemotherapy is usually poor, infection control in the patient is very important.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Wiwanitkit V. Antiviral drug treatment for emerging swine flu. Clin Ter 2009;160:243-5.  Back to cited text no. 1
Wiwanitkit V. Non respiratory manifestations of swine flu. Clin Ter 2009;160:499-501.  Back to cited text no. 2
Wiwanitkit V. Swineflu: high mortality in cancer patients. Indian J Cancer 2010;47:231.  Back to cited text no. 3
Kidd IM, Down J, Nastouli E, Shulman R, Grant PR, Howell DC, et al. H1N1pneumonitis treated with intravenous zanamivir. Lancet 2009;19:374-1036.  Back to cited text no. 4
Vandroux D, Lugagne-Delpon N, Bossard G, Drouet D, Djourhi S, Jaffar-Bandjee MC, et al. One case of nosocomial A(H1N1)2009 influenza in Réunion Island. Bull Soc Pathol Exot 2011;104:105-7.Ñamendys-Silva SA, Pérez-Jiménez C, Cornejo-Juárez P,   Back to cited text no. 5
Vilar-Compte D, Volkow P. Prolonged lymphopenia in a patient with lymphoma and severe Pandemic influenza AH1N12009 virus infection. Influenza Other Respir Viruses 2011;5:167-9.  Back to cited text no. 6
Babor F, Grund S, Siepermann M, Oommen PT, Kuhlen M, Schuster FR. Epidemiology and clinical characteristics of pandemic (H1N1) 2009 influenza infection in pediatric hemato-oncology and hematopoietic stem cell transplantation patients. Transpl Infect Dis 2012;14:589-94.  Back to cited text no. 7
Katsumi A, Nishida T, Murata M, Terakura S, Shimada K, Saito S. et al. Virus-associated hemophagocytic syndrome caused by pandemic swine-origin influenza A (H1N1) in a patient after unrelated bone marrow transplantation. J Clin Exp Hematop 2011;5163-5.  Back to cited text no. 8
Wiwanitkit V. Influenza vaccination forcancerpatients: tertiary prevention of mortality. Asian Pac J Cancer Prev 2009;10:717-8.  Back to cited text no. 9
Bedognetti D, Zoppoli G, Massucco C, Zanardi E, Zupo S, Bruzzone A, et al. Impaired response to influenza vaccine associated with persistent memory B cell depletion in non-Hodgkin'slymphomapatients treated with rituximab-containing regimens. J Immunol 2011;186:6044-55.  Back to cited text no. 10
Monkman K, Mahony J, Lazo-Langner A, Chin-Yee BH, Minuk LA. The pandemicH1N1influenza vaccine results in low rates of seroconversion for patients with hematological malignancies. Leuk Lymphoma 2011;52:1736-41.  Back to cited text no. 11
Yri OE, Torfoss D, Hungnes O, Tierens A, Waalen K, Nordøy T, et al. Rituximab blocks protective serologic response to influenza A (H1N1) 2009 vaccination in lymphoma patients during or within 6 months after treatment. Blood 2011;118:6769-71.  Back to cited text no. 12
Hottinger AF, George AC, Bel M, Favet L, Combescure C, Meier S, et al. A prospective study of the factors shaping antibody responses to the AS03-adjuvanted influenza A/H1N1vaccine in cancer outpatients. Oncologist 2012;17:436-45.  Back to cited text no. 13
Villa D, Gubbay J, Sutherland DR, Laister R, McGeer A, Cooper C. et al. Evaluation of 2009 pandemicH1N1influenza vaccination in adults with lymphoid malignancies receiving chemotherapy or following autologous stem cell transplant. Leuk Lymphoma 2013;54:1387-95.  Back to cited text no. 14
Strowd RE, Swett K, Harmon M, Carter AF, Pop-Vicas A, Chan M, et al. Influenza vaccine immunogenicity in patients with primary central nervous system malignancy. Neuro Oncol 2014;16:1639-44.  Back to cited text no. 15
Bedognetti D, Ansaldi F, Zanardi E, Durando P, Sertoli MR, Massucco C. et al. Seasonal and pandemic (A/H1N12009) MF-59-adjuvanted influenza vaccines in complete remission non-Hodgkinlymphomapatients previously treated with rituximab containing regimens. Blood 2012;120:1954-7.  Back to cited text no. 16

Correspondence Address:
Viroj Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.196750

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