N Engl J Med. Blood. Treatment of an acyclovir and foscarnet-resistant herpes simplex virus infection with cidofovir in a child after an unrelated bone marrow transplant.

UL54 mutations occur within the cluster of conserved regions of homology (exonuclease domains I through III and polymerization domains I through III) thus conferring various patterns of cross-resistance among the antiviral drugs [70]. Allogeneic Hematopoietic Stem Cell Transplant for People With Primary Immunodeficiency Diseases. [, Hiwarkar P, Amrolia P, Sivaprakasam P, Lum SH, Doss H, O'Rafferty C, et al. [, Tyring S, Belanger R, Bezwoda W, Ljungman P, Boon R, Saltzman RL, et al. PTLD can also occur after 1 year of transplant in about 4% of cases [100]. [, Wu KH, Weng T, Wu HP, Peng CT, Sheu JN, Chao YH. EBV-associated post-transplant lymphoproliferative disorder following in vivo T-cell-depleted allogeneic transplantation: Clinical features, viral load correlates and prognostic factors in the rituximab era. 2002; 46: 2969-2976. Ann Pharmacother. Impact of pretransplant donor and recipient cytomegalovirus serostatus on outcome for multiple myeloma patients undergoing reduced intensity conditioning allogeneic stem cell transplantation. h�bbd``b` �k��2�`��� ����$�U��$7D���Z�g)H�Jd3��w����e����������/� vS* endstream endobj startxref 0 %%EOF 1076 0 obj <>stream Marcos de Lima, MD, vice-chair of the NCCN Guidelines Panel for HCT, agreed, highlighting the importance of guidelines being issued in tandem with the increase of donors over the years. [, Papanicolaou GA, Silveira FP, Langston AA, Pereira MR, Avery RK, Uknis M, et al. It is recommended to postpone conditioning chemotherapy in HSCT patients with an upper respiratory infection (URI), as it can progress to lower respiratory infection (LRI) during immunosuppression [139,140].

[, Papadopoulos EB, Ladanyi M, Emanuel D, Mackinnon S, Boulad F, Carabasi MH, et al. More studies are needed to determine the indications, efficacy and feasibility of using brincidofovir as HSV prophylaxis.

Post-transplant acute limbic encephalitis: Clinical features and relationship to HHV6. Prolonged use of low dose acyclovir is also one of the causative factors [31]. endstream 2012; 56: 1135-1137. Risk factors for developing resistance include previous anti-CMV drug exposure for a prolonged duration, inadequate dosing, bioavailability or absorption, profound immunosuppression, and corticosteroids usage. [, Erard V, Chien JW, Kim HW, Nichols WG, Flowers ME, Martin PJ, et al.

Buchsbaum RJ, Fabry JA, Lieberman J. EBV-specific cytotoxic T lymphocytes protect against human EBV-associated lymphoma in scid mice. [, Heslop HE.

17 0 obj Hepatitis B and C in hematopoietic stem cell transplant. [, Kleemann P, Distler E, Wagner EM, Thomas S, Klobuch S, Aue S, et al. Admission day: • You will have an appointment the morning of your admission day with your transplant doctor to ensure that you are ready for your chemotherapy 340 0 obj <> endobj 2010; 89: 1533-1540. 9 0 obj Adv Ther. A phase 1/2 trial of arginine butyrate and ganciclovir in patients with Epstein-Barr virus-associated lymphoid malignancies. In symptomatic patients, a nasal swab sample for multiplex viral polymerase chain reaction (PCR) is the preferred method to diagnose viral infections [138]. 2016; 72: 214-222. Adenovirus infection rates in pediatric recipients of alternate donor allogeneic bone marrow transplants receiving either antithymocyte globulin (ATG) or alemtuzumab (Campath). 2005; 366: 733-741. 2013; 5: e2013026. Immediate post-engraftment phase from engraftment to day 100 and late post-engraftment phase after day 100 [18]. P T. 2019; 44: 9-11.

Bone Marrow Transplant. 2006; 44: 1571-1574. Semiquantitative Epstein-Barr virus polymerase chain reaction analysis of peripheral blood from organ transplant patients and risk for the development of lymphoproliferative disease. Blood. Adoptive cellular therapy for early cytomegalovirus infection after allogeneic stem-cell transplantation with virus-specific T-cell lines. Blood. [, Lalezari JP, Aberg JA, Wang LH, Wire MB, Miner R, Snowden W, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: A global perspective. [, Lal H, Cunningham AL, Godeaux O, Chlibek R, Diez-Domingo J, Hwang SJ, et al. Kedes DH, Ganem D. Sensitivity of Kaposi's sarcoma-associated herpesvirus replication to antiviral drugs. Bone Marrow Transplant. High dose valacyclovir prophylaxis (2 grams 4 times a day) has shown a reduction in CMV infection [39].

Discovery and epidemiology of the human polyomaviruses BK virus (BKV) and JC virus (JCV). Human herpesvirus 6 chromosomal integration in immunocompetent patients results in high levels of viral DNA in blood, sera, and hair follicles. When you have an allogeneic stem cell transplant, stem cells are harvested (collected) from a donor. Due to the variability of PCR techniques a specific threshold to initiate pre-emptive therapy is not recommended [11]. Leukemia. In vivo B-cell depletion with rituximab for alternative donor hemopoietic SCT. endstream endobj 341 0 obj <>/Metadata 23 0 R/Pages 338 0 R/StructTreeRoot 39 0 R/Type/Catalog>> endobj 342 0 obj <>/MediaBox[0 0 612 792]/Parent 338 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 343 0 obj <>stream Valacyclovir has better oral bioavailability and is equally effective as HSV prophylaxis. [, Emery VC, Sabin CA, Cope AV, Gor D, Hassan-Walker AF, Griffiths PD. Pre-hydration and electrolyte monitoring should be done in patients receiving foscarnet to prevent nephrotoxicity. [, Smith KO, Galloway KS, Kennell WL, Ogilvie KK, Radatus BK. 1996; 22: 778-782. Blood. This failed to achieve reduction in BK viruria and viremia and also lead to antibiotic resistance and tendinitis [168]. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Bone Marrow Transplant. [, Ljungman P, de la Camara R, Cordonnier C, Einsele H, Engelhard D, Reusser P, et al. Bone Marrow Transplant.

Transpl Infect Dis. Valacyclovir versus acyclovir for HSV prophylaxisin neutropenic patients. Ex-vivo stimulation and expansion requires a small volume of blood. [, Hantz S, Garnier-Geoffroy F, Mazeron MC, Garrigue I, Merville P, Mengelle C, et al. Fiore AE, Shay DK, Haber P, Iskander JK, Uyeki TM, Mootrey G, et al. Early treatment with weekly rituximab monotherapy for up to 4 weeks along with EBV viral load monitoring is associated with a positive outcome in about 70% of patients [103]. 2008; 27: 75-77. Clin Infect Dis. 2006; 27: 254-298. Adoptive transfer and selective reconstitution of streptamer-selected cytomegalovirus-specific CD8+ T cells leads to virus clearance in patients after allogeneic peripheral blood stem cell transplantation. endobj Many prophylactic and pre-emptive treatment strategies are also aimed at decreasing viral infection-related complications [6]. Patients undergoing haplo transplant with PT-Cy have intermediate risk and patients undergoing matched or mismatched unrelated donor transplant have a high risk of developing EBV disease [103]. <> Brincidofovir has been successfully used in immunocompromised patients who had failed cidofovir [162].
Pediatr Blood Cancer. 2018; 33: 256-276.
Antiviral Res. yPc�#��Y�M��g(ɷ8��.�c���3m&���iô�%$S�FŬ�5s�FÂV-��Z�I+i�3�- �!� LIr�S�S{I�(���048��Ё8�[����c*�à�( ������U�u*H���_�\�s>yZe���=&����]��X����]���� ]}���}żJ�0���()��?/�U�_(�2_UEɿ7q*+NOoBq��պ�ī'%�����z�c7�j��\��%�}d�^�9�Z�|�:):�驽�,YI6oj�3�{Ȧ�h���D�t�Q��Q8[��i~�/{�u��}���jp��-��. Reactivation of VZV causes herpes zoster [1]. This has activity against viruses resistant to other antiviral molecules.

Most of these viral infections are opportunistic in nature and are related to factors influencing engraftment and immune reconstitution [1].

2001; 19: 13-22. Adverse reactions were of mild to moderate intensity and immunization did not affect disease relapse or graft failure [49]. Lancet. Mediterr J Hematol Infect Dis. Transpl Infect Dis. endstream endobj startxref

Intravenous immunoglobulins (IVIG) can be given in case of hypogammaglobulinemia and recurrent infections [103,107]. The vaccine should be given ≥24 months following transplantation [11,46]. One aspect of importance in the guidelines is how to evaluate a potential transplant recipient to determine if the patient is an appropriate candidate for the procedure. 2010; 10: 147. 2008; 46: 402-412. Patients with primary, disseminated and severe mucocutaneous HSV infections are placed under contact precautions. Blood. The median time to development of PTLD is around 2 to 4 months [100,102]. [, Battiwalla M, Paplham P, Almyroudis NG, McCarthy A, Abdelhalim A, Elefante A, et al. [, Stadtmauer EA, Sullivan KM, Marty FM, Dadwal SS, Papanicolaou GA, Shea TC, et al.

Interestingly, haplo-identical transplants using post-transplant cyclophosphamide (PT-Cy) had a low incidence of PTLD [101]. 1. Universal droplet and isolation precautions are practiced as for other respiratory and enteric viruses to prevent a nosocomial spread [11]. HSV2 infections are less frequent and there are broad regional variations [22]. Immunol Lett.

Reference: National Comprehensive Cancer Network. EBV matched donor is recommended to reduce the risk of EBV disease [103]. Using CMV intravenous immunoglobulins as an adjunct therapy is controversial due to lack of data [70]. Viral infections have emerged as a major challenge causing high morbidity and mortality in stem cell transplant recipients. [, Quintela A, Escuret V, Roux S, Bonnafous P, Gilis L, Barraco F, et al. Br J Haematol. Remember that the following may not apply to each

2014; 49: 280-286. [, Gratwohl A, Brand R, Frassoni F, Rocha V, Niederwieser D, Reusser P, et al. The chickenpox vaccine has low viral titers and can be used in varicella – seronegative HSCT recipients who do not have active GVHD and are not receiving immunosuppression. 2005; 36: 1001-1008. 1994; 330: 1185-1191. Paradoxical rising cytomegalovirus antigenemia during preemptive ganciclovir therapy in hematopoietic stem cell transplant recipients: Incidence, risk factors, and clinical outcomes. When possible immunosuppression should be reduced and donor or third party EBV specific CTLs should be infused for efficient control of EBV viremia [103]. The 3 general sources of stem cells that can be used in an allogeneic stem cell transplant are: Peripheral blood stem cells. h�b```�.uA��1�F�k{:X&$~��`�����^R�Rst�J������m-�n3L�NNr}���� Kaohsiung J Med Sci. 2011; 49: 4179-4184. J Clin Microbiol. Infusions of donor leukocytes to treat Epstein-Barr virus-associated lymphoproliferative disorders after allogeneic bone marrow transplantation.

2007; 40: 125-136.

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