How I prevent viral reactivation in high-risk patients

Preventing viral infections at an early stage is a key strategy for successfully improving transplant outcomes. Pre-emptive therapy and prophylaxis with antiviral agents have been successfully used to prevent clinically significant viral infections in hematopoietic cell transplant recipients. Major progress has been made over the past decades in preventing viral infections through a better understanding of the biology and risk factors, as well as the introduction of novel antiviral agents and advances in immunotherapy. High-quality evidence exists for the effective prevention of herpes simplex virus, varicella-zoster virus, and cytomegalovirus infection and disease. Few data are available on the effective prevention of human herpesvirus 6, Epstein-Barr virus, adenovirus, and BK virus infections. To highlight the spectrum of clinical practice, here we review high-risk situations that we handle with a high degree of uniformity and cases that feature differences in approaches, reflecting distinct hematopoietic cell transplant practices, such as ex vivo T-cell depletion.

Automated summary

Preventing viral infections in transplant recipients is crucial. Pre-emptive therapy and prophylaxis with antiviral agents have successfully prevented clinically significant viral infections. Progress has been made in understanding the biology and risk factors of viral infections, as well as the development of new antiviral agents and immunotherapy. Effective prevention strategies exist for herpes simplex virus, varicella-zoster virus, and cytomegalovirus, but limited data are available for other viral infections in transplant recipients.