Management of herpesvirus reactivations in patients with solid tumours and hematologic malignancies: update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) on herpes simplex virus type 1, herpes simplex virus type 2, and varicella zoster virus

Larissa Henze,Michael Sandherr,Rosanne Sprute,Christoph Buhl,Til Ramon Kiderlen,Marie Von Lilienfeld-Toal,Yascha Khodamoradi,Alrun Seidler,Werner J Heinz,Philipp Koehler,Martin Schmidt-Hieber,Oliver A Cornely

doi:10.1007/s00277-021-04746-y

Abstract

Clinical reactivations of herpes simplex virus or varicella zoster virus occur frequently among patients with malignancies and manifest particularly as herpes simplex stomatitis in patients with acute leukaemia treated with intensive chemotherapy and as herpes zoster in patients with lymphoma or multiple myeloma. In recent years, knowledge on reactivation rates and clinical manifestations has increased for conventional chemotherapeutics as well as for many new antineoplastic agents. This guideline summarizes current evidence on herpesvirus reactivation in patients with solid tumours and hematological malignancies not undergoing allogeneic or autologous hematopoietic stem cell transplantation or other cellular therapy including diagnostic, prophylactic, and therapeutic aspects. Particularly, strategies of risk adapted pharmacological prophylaxis and vaccination are outlined for different patient groups. This guideline updates the guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) from 2015 “Antiviral prophylaxis in patients with solid tumours and haematological malignancies” focusing on herpes simplex virus and varicella zoster virus.

Highlights

Herpesviridae persist — after primary infection usually in childhood or adolescence — lifelong in their hosts and can reactivate in situations of immune deficiency, like malignant diseases
In patients with normal renal function, acyclovir is recommended with 400 mg orally Twice daily (BID)
In patients with normal renal function, acyclovir is recommended with 400 mg orally BID and valacyclovir is recommended with 500 mg orally BID

Summary

Introduction

Herpesviridae persist — after primary infection usually in childhood or adolescence — lifelong in their hosts and can reactivate in situations of immune deficiency, like malignant diseases. To prevent herpes zoster vaccination has become available as general prophylaxis and is recommended for adults aged 50 years or older. Systematic analyses and trials of herpesvirus reactivation in patients with solid tumours or hematologic malignancies who are not candidates for HSCT are limited [4] but increasing, acknowledging the variable risks in the era of new therapeutics. This guideline summarizes current evidence on herpesvirus reactivation in patients with solid tumours and hematologic malignancies not undergoing allogeneic or autologous HSCT or cellular therapy (CAR T cell therapy) and constitutes an update of the guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) of 2015 “Antiviral prophylaxis in patients with solid tumours and hematological malignancies” [9] focusing on HSV-1, HSV-2, and VZV

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Conclusion