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Prevention of viral infections in hematopoietic cell transplant recipients

Author
John R Wingard, MD
Section Editor
Kieren A Marr, MD
Deputy Editor
Anna R Thorner, MD

INTRODUCTION

Hematopoietic cell transplant (HCT) recipients, especially those who have received allogeneic transplants, are at increased risk for a variety of infections depending upon their degree of immunosuppression and exposures. The term "hematopoietic cell transplantation" will be used throughout this topic as a general term to cover transplantation of progenitor cells from any source (eg, bone marrow, peripheral blood, umbilical cord blood). (See "Sources of hematopoietic stem cells".)

Infection in HCT recipients is associated with high morbidity and mortality. Viruses of major importance in HCT recipients include herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), respiratory viruses (eg, influenza, parainfluenza, respiratory syncytial virus, adenovirus), human herpes virus 6 (HHV-6), hepatitis B, and hepatitis C. Antiviral prophylaxis or preemptive therapy against some of these viruses is recommended for HCT recipients and will be discussed here. An overview of infections following HCT, evaluation for infections before HCT, prophylaxis of other infections in HCT recipients, and immunizations in HCT candidates and recipients are presented separately. (See "Overview of infections following hematopoietic cell transplantation" and "Evaluation for infection before hematopoietic cell transplantation" and "Prevention of infections in hematopoietic cell transplant recipients" and "Prophylaxis of invasive fungal infections in adult hematopoietic cell transplant recipients" and "Prophylaxis of infection during chemotherapy-induced neutropenia in high-risk adults" and "Immunizations in hematopoietic cell transplant candidates and recipients".)

GUIDELINES

In 2009, guidelines for preventing infectious complications after HCT were published, which represent the collaboration of several organizations from Europe and North America, including the European Blood and Marrow Transplant Group, the American Society of Blood and Marrow Transplantation, the Canadian Blood and Marrow Transplant Group, the Infectious Diseases Society of America, and the United States Centers for Disease Control and Prevention [1]. Our recommendations are generally in keeping with these guidelines.

The National Comprehensive Cancer Network has also published guidelines for the prevention and treatment of cancer-related infections [2].

EVALUATION BEFORE HCT

The pretransplantation evaluation is designed to prevent posttransplant infections by excluding unsuitable donors and defining specific infection control policies and antimicrobial prophylaxis and therapy regimens, which will be necessary after transplantation. Laboratory testing for evidence of past infectious exposures is performed to detect asymptomatic infection in the HCT donor or candidate. Some tests are recommended for all HCT donors and candidates, whereas others are appropriate in selected individuals with epidemiologic risk factors (table 1) [1,3]. Serologic testing is used as an indicator of significant past exposures.

                                                 

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Literature review current through: Nov 2016. | This topic last updated: Mon May 09 00:00:00 GMT+00:00 2016.
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