Antiviral prophylaxis in patients with haematological malignancies and solid tumours: Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Oncology (DGHO)

Abstract

Morbidity and mortality in patients with malignancies are increased by viral infections. These mostly are reactivations of asymptomatic latent infections. They primarily concern clinical entities associated with the reactivation of herpes viruses, such as varicella zoster virus (VZV) and cytomegalovirus (CMV). Respiratory tract infections caused by influenza, parainfluenza or respiratory syncytial virus (RSV) are less common. Since reactivation of latent infections has major clinical impact, antiviral prophylaxis is an attractive approach for patients expecting immunosuppression. The main risk factor for clinically relevant reactivation is profound disruption of cellular immune response. Duration and severity of chemotherapy induced neutropenia are of lesser importance. The risk of viral complications rises significantly in the presence of sustained suppression of T-cell function, e.g. in recipients of allogeneic stem cell transplants or of alemtuzumab (Campath-1H) antibody therapy. The objective of this guideline is to review the basis of prophylactic strategies and to provide recommendations for clinicians treating patients with haematological malignancies and solid tumors.

Profilaxis de infección por virus respiratorios en niños y adultos sometidos a trasplante de órganos sólidos y precursores hematopoyéticos

“…Considerando la elevada mortalidad en población de receptores de trasplantes, la vacunación estacional con virus inactivado está indicada en todos los pacientes candidatos a TOS o TPH tres meses antes del trasplante y a partir del sexto mes post-trasplante (A2) 29,[31][32][33] . La respuesta a la vacuna depende del tipo de régimen de inmunosupresión, como del momento en que se indica 34 .…”

Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab

“…Antiviral prophylaxis is generally not recommended in the SCT setting if the donor and recipient are seronegative for viral titers. Prophylaxis for HSV/VZV is not recommended unless the patient is seropositive and has additional risk factors including low CD4 count (<50/μL), previous corticosteroid or fludarabine treatment, a background of recurring herpes infections, or total body irradiation during conditioning [53]. Acyclovir 400 mg QD or three times per day (TID) is recommended if the donor or recipient is HSV seropositive.…”

“…Acyclovir or valacyclovir both have similar prophylactic efficacy for patients with hematological malignancies [60]. For patients who are seropositive for hepatitis B virus, lamivudine 100 mg/day is recommended as prophylaxis, although it has the potential to enhance the risk of developing hepatitis B-resistant viral strains [53].…”

Human Herpesviruses in Hematologic Diseases

“…The rate of HSV reactivation among HSV seropositive allo-Stem Cell Transplant recipients was reported to be approximately 80%, with the majority of these infections occurring during the first four weeks after transplant. They are also common, ranging from 15% among CLL (chronic lymphocytic leukemia) patients treated with fludarabine to 90% of patients with acute leukemia (Sandherr et al, 2006;Anaisse et al, 1998). Most individuals undergoing conventional chemotherapy are at low risk of HSV reactivation; however, those receiving T-cell depleting agents (e.g.…”