Management of HSV, VZV and EBV infections in patients with hematological malignancies and after SCT: guidelines from the Second European Conference on Infections in Leukemia

Abstract

These guidelines on the management of HSV, VZV and EBV infection in patients with hematological malignancies and after SCT were prepared by the European Conference on Infections in Leukemia following a predefined methodology. A PubMed search was conducted using the appropriate key words to identify studies pertinent to management of HSV, VZV and EBV infections. References of relevant articles and abstracts from recent hematology and SCT scientific meetings were also reviewed. Prospective and retrospective studies identified from the data sources were evaluated, and all data deemed relevant were included in this analysis. The clinical and scientific background was described and discussed, and the quality of evidence and level of recommendation were graded according to the Centers for Disease Control criteria.

Manifestations of Fulminant CD8 T-cell Post-transplant Lymphoproliferative Disorder Following the Administration of Rituximab for Lymphadenopathy with a High Level of Epstein-Barr Virus (EBV) Replication after Allogeneic Hematopoietic Stem Cell Transplantation

“…This case suggests that performing a biopsy in the initial stage of the disease is essential for confirming the diagnosis of PTLD (17) and that a sequential analysis to identify the lineage of the EBV-infected cells should be conducted when administering rituximab in patients with a high level of EBV replication.…”

Severe herpes simplex oral mucositis in a patient with non-Hodgkin’s lymphoma after autologous stem cells transplantation – Case Report

“…or 40 mg/kg/body weight every 8 hours for 7-21 days until complete healing of lesions. Cidofovir is recommended at a dose of 5 mg/kg/body weight, once a week for 2 weeks of treatment [11]. Acyclovir prophylaxis is indicated in seropositive patients.…”

“…It becomes ineffective in the case of mutation of the genome of HSV-1 virus consisting in deficiency of thymidine kinase [10]. Alternative drugs for resistance to acyclovir are: foscarnet, valganyclovir and cidofovir, which act independently of the level of thymidine kinase [1,11,12]. Foscarnet is used at a dose of 60 mg/kg/body weight every 12 hours i.v.…”

“…The drug of choice in the prevention of HSV-1 in patients undergoing HSCT is acyclovir, administered orally in a daily prophylactic dose of 600-1200 mg, or intravenously 250 mg/m 2 every 12 hours [1]. The treatment of an active HSV-1 infection consists in administration of intravenous acyclovir at a dose of 5 mg/kg body weight, every 8 hours for 7-10 days [11]. It becomes ineffective in the case of mutation of the genome of HSV-1 virus consisting in deficiency of thymidine kinase [10].…”

Features of EBV reactivation after reduced intensity conditioning unrelated umbilical cord blood transplantation

“…7,28 In addition, an ever growing number of studies suggested that preemptive therapy with rituximab may be highly effective in controlling viral proliferation and avoiding progression into EBV-related LPD. 29,30 Of note, the efficacy of rituximab was mainly observed in the preemptive setting, but to a lesser extent once EBV-related LPD was fully established.…”