Abstract
Viral infections are important causes of morbidity and mortality after allogeneic stem cell hematopoietic transplantation (allo-HSCT). Although most viral infections present with asymptomatic or subclinical manifestations, viruses may result in fatal complications in severe immunocompromised recipients. Reactivation of latent viruses, such as herpesviruses, is frequent during the immunosuppression that occurs with allo-HSCT. Viruses acquired from community, such as the respiratory and gastrointestinal viruses, are also important pathogens of post-transplant viral diseases. Currently, molecular diagnostic methods have replaced or supplemented traditional methods, such as viral culture and antigen detection, in diagnosis of viral infections. The utilization of polymerase chain reaction facilitates the early diagnosis. In view of lacking efficacious agents for treatment of viral diseases, prevention of viral infections is extremely valuable. Application of prophylactic strategies including preemptive therapy reduces viral infections and diseases. Adoptive cellular therapy for restoring virus-specific immunity is a promising method in the treatment of viral diseases.
Highlights
Viral infections are common complications after allogeneic hematopoietic stem cell transplantation
With wide use of HLA-mismatch, unrelated and cord blood donors as alternative sources of hematopoietic stem cells, and anti-thymocyte globulin (ATG) as the standard prophylaxis of graft versus host disease (GVHD) in HLA-mismatch and unrelated donor transplantation, allo-HSCT recipients are at increasing risk for viral infections [1,2,3,4,5]
The aim of this article is to review the current concepts of diagnosis, prevention and treatment of viral diseases in the recipients of alloHSCT
Summary
Viral infections are common complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Epidemiology In the recipients of allo-HSCT, the difference in the reported incidence is due in part to asymptomatic or subclinical manifestations in most of viral infections and the changing epidemiology of viruses as well as differences in diagnostic methods [18,19,20,21,22,23]. In the recipients of allo-HSCT, immunotherapeutic strategies to restore virus-specific immunity, such as reducing immunosuppressants, DLI and ex vivo generation of virusspecific CTL, are advocated in the treatment of viral diseases [14,25,49]. Reducing immunosuppressants is unfeasible in many patients due to potential risk of GVHD [24,25], and DLI is limited by unavailable stem
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