ASK DIS: 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:

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

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