Management of herpesvirus reactivations in patients with solid tumours and hematologic malignancies: update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) on herpes simplex virus type 1, herpes simplex virus type 2, and varicella zoster virus
DGHO-AGIHO · 2022 · Germany
Source and licence
- Authors
- Larissa Henze, Christoph Buhl, Michael Sandherr et al.
- Title
- Management of herpesvirus reactivations in patients with solid tumours and hematologic malignancies: update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) on herpes simplex virus type 1, herpes simplex virus type 2, and varicella zoster virus
- Journal
- Annals of Hematology, 2022
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC8810475
Licence statement of the original publication
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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Pharmacological prophylaxis
- We recommend oral acyclovir 400 mg BID or 400 mg QID as prophylaxis of oral HSV disease (AIIr). Oral valacyclovir can be used alternatively (BI), but the best regimen (250 mg BID or 500 mg BID) has not yet been defined. For patients not tolerating oral medication, intravenous acyclovir 250 mg/m2 TID is suitable (AIIr).
- We recommend oral acyclovir to reduce clinical VZV reactivation; dosages from 400 mg once daily to 400 mg TID have been shown to be effective (AII). Valacyclovir may also be effective by mechanism of action and due to transferred evidence, but has rarely been systematically tested [63, 64] (CIIu). For patients not tolerating oral medication, intravenous acyclovir is suitable, but evidence on the most appropriate dosage is lacking (BIIt).
Abstract
Clinical reactivations of herpes simplex virus or varicella zoster virus occur frequently among patients with malignancies and manifest particularly as herpes simplex stomatitis in patients with acute leukaemia treated with intensive chemotherapy and as herpes zoster in patients with lymphoma or multiple myeloma. In recent years, knowledge on reactivation rates and clinical manifestations has increased for conventional chemotherapeutics as well as for many new antineoplastic agents. This guideline summarizes current evidence on herpesvirus reactivation in patients with solid tumours and hematological malignancies not undergoing allogeneic or autologous hematopoietic stem cell transplantation or other cellular therapy including diagnostic, prophylactic, and therapeutic aspects. Particularly, strategies of risk adapted pharmacological prophylaxis and vaccination are outlined for different patient groups. This guideline updates the guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) from 2015 “Antiviral prophylaxis in patients with solid tumours and haematological malignancies” focusing on herpes simplex virus and varicella zoster virus.
Contents of the original publication
The section headings of the original.
- Introduction
- Methods
- Manifestations of HSV-1, HSV-2, and VZV
- Diagnostics
- Serology
- Virus detection
- Testing of resistance
- Contribution of imaging techniques to diagnosis
- Pharmacological prophylaxis
- Vaccination
- Patient groups
- Patients with solid tumours
- Patients with acute leukaemia
- Patients with myeloproliferative neoplasm
- Patients with lymphoma
- Patients with chronic lymphocytic leukaemia
- Patients with multiple myeloma
- Treatment
- Conclusion
- Code availability
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