Prophylaxis And Therapy

Patients with chronic GVHD should receive prophylactic antibiotic therapy directed against encapsulated organisms as long as immunosuppressive treatment is being administered; the regimen should be selected based upon local resistance patterns of S. pneumoniae and H. influenzae.2 The 23-valent pneumococcal polysaccharide vaccine should be administered 12-24 months after HSCT and HiB conjugate vaccine should be given at 12, 14, and 24 months as well.2 Patients with hypogammaglobulinemia may require replacement therapy if they experience recurrent infections with encapsulated organisms, or at the time of a serious first episode.

CMV prophylaxis is not recommended beyond day 100, but high-risk patients should receive biweekly screening. Ganciclovir should be administered for at least 3 weeks if viremia is detected. EBV and VZV prophylaxis are not recommended.2 Anecdotal reports have suggested efficacy of acyclovir and ganciclovir in patients with PTLD, but no large trials have been performed and antiviral therapy is not recommended.2 If possible, immunosuppression should be reduced if PTLD is identified. The administration of donor-derived, EBV-specific cytotoxic T cells has demonstrated promise in the prevention of PTLD in high-risk patients.61 Influenza immunization is indicated on an annual basis beginning 6 months after HSCT.2

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