AntiViral Prophylaxis forchemotherapy-induced neutropenia

INFLUENZA

• Prevention of influenza virus should be considered well in advance of the development of neutropenia.
• Annual immunization with an inactivated influenza vaccine is recommended for all patients being treated for cancer
• generally administered >2 weeks before chemotherapy starts or, between chemotherapy cycles and at least seven days after the last cycle

HSV & VZV

• Reactivation of herpes simplex virus (HSV)-1 and HSV-2 are important causes of morbidity in patients with acute leukemia and those undergoing HCT
• varicella-zoster virus (VZV) reactivation occurs commonly in HCT recipients who are not receiving prophylaxis
• Patients who are seropositive for HSV and who are undergoing allogeneic HCT or induction chemotherapy for acute leukemia should receive antiviral prophylaxis withacyclovir (400 mg orally 3/4 times daily or 800 mg orally twice daily)
• continued until recovery of the white blood cell count or resolution of mucositis
• In HCT recipients who are seropositive for VZV, antiviral prophylaxis with acyclovir (800 mg orally twice daily) is typically continued for one year or longer in those with chronic GVHD and/or who require ongoing immunosuppression 

CMV

• Reactivation of cytomegalovirus (CMV) does not occur commonly in patients, preemptive therapy is therefore not indicated
• In contrast, HCT recipients are at significant risk for CMV reactivation

HEPATITIS B

• Patients receiving chemotherapy who have a history of previous hepatitis B virus infection are at risk of reactivation with a flare of hepatitis that may potentially result in hepatic failure
• Antiviral prophylaxis should be considered for such patients at risk for reactivation and should be continued for at least six months after the completion of chemotherapy 
• This strategy can reduce the risk of reactivation from 24 to 53 percent to 0 to 5 percent

REFERENCE:

1. www.uptodate.com
2. NCCN Guidelines version 01.2013 Prevention and Treatment of Cancer Related Infection