How I Prevent Viral Reactivation in High-risk Patients

Preventing viral infections at an early stage is a key strategy of successfully improving transplant outcomes. Preemptive therapy and prophylaxis using antiviral agents have been used successfully to prevent clinically significant viral infections in hematopoietic cell transplant (HCT) 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 immunotherapies. High quality evidence exists for the effective prevention for herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV) infection and disease. Fewer data are available on the effective prevention of human herpesvirus 6 (HHV-6), Epstein-Barr virus (EBV), Adenovirus (ADV) 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 HCT practices such as ex-vivo T cell depletion.