Sandherr, M., Hentrich, M., Von Lilienfeld-Toal, M., Massenkeil, G., Neumann, S., Penack, O., . . . Cornely, O.A. (2015). Antiviral prophylaxis in patients with solid tumours and haematological malignancies—Update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Annals of Hematology, 94, 1441–1450.

DOI Link

Purpose & Patient Population

PURPOSE: To provide evidence-based recommendations for the prevention of viral reactivation and primary viral infections
 
TYPES OF PATIENTS ADDRESSED: Patients undergoing antineoplastic treatment other than allogeneic hematopoietic cell transplantation (HCT)

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Consensus-based guideline

PROCESS OF DEVELOPMENT: Relevant literature was reviewed, and an expert panel from AGIHO composed the guidelines.
 
DATABASES USED: MEDLINE, CANCERLIT, Cochrane Collaboration, and presentations from meetings of ASH, EHA, ASCO, ESMO, ECCMID, and ICAAC
 
INCLUSION CRITERIA: Not stated
 
EXCLUSION CRITERIA: Not stated

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care

Results Provided in the Reference

Not provided

Guidelines & Recommendations

The influenza vaccine is recommended in patients with active malignancy undergoing chemotherapy, patients with acute leukemia after chemotherapy, and all patients during maintenance treatment. Insufficient evidence exists for acyclovir prophylaxis for preventing herpes simplex virus (HSV), Epstein-Barr virus (EBV), and varicella-zoster virus (VZV) reactivation. The guidelines provide an algorithm for hepatitis B virus (HBV) reactivation prophylaxis, including screening, monitoring, and intervention based on positive HSs antigen and units of HBc DNA identified. Primary antiviral prophylaxis with nucleoside analogues for hepatitis B are effective in reducing risk. The guidelines identify risk factors for HBV reactivation:

  • Treatment with anthracyclines
  • Treatment with steroids (greater than 10–20 mg daily or equivalent for four weeks or more)
  • Treatment with monoclonal antibodies
  • Breast cancer or malignant lymphoma

Limitations

  • Limited search documentation

Nursing Implications

These guideline add to the body of evidence recommending influenza vaccination in patients undergoing cancer treatment. This guideline does not recommend other routine prophylaxis and does provide suggestions regarding specific agents for prophylaxis according to individual patient risk factors based on disease, history, and treatment type.