Complex management of resistant oral herpes simplex virus infection following hematopoietic stem cell transplantation: potential role of topical cidofovir

Epstein, Joel B.; Gharapetian, Sara; Rejali, Ali Reza; Zabner, Rachel; Lill, Michael; Tzachanis, Dimitrios

doi:10.1007/s00520-016-3264-5

Cited by 12 publications

(11 citation statements)

References 18 publications

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“…This problem can be overcome by the topical use of cidofovir solution and gel. Successful treatment of ACVr HSV stomatitis by topical cidofovir in HCT patients was described in case reports [9,10,[16][17][18]. Sims et al [10] published data for the topical use of 3% cidofovir oral rinse solution, and Muluneh et al [9] reported the use of topical 1% cidofovir gel in HCT patients.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Topical Treatment of Acyclovir-Resistant Herpes Simplex Virus Stomatitis after Allogeneic Hematopoietic Cell Transplantation

Heidenreich¹,

Kreil²,

Mueller³

et al. 2020

Oncol Res Treat

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Introduction: We report on patients who developed severe acyclovir-resistant (ACVr) herpes simplex virus 1 (HSV-1) stomatitis after allogeneic hematopoietic cell transplantation (HCT). Patients: HCT patients suffering from HSV-1 stomatitis without response after 1 week of high-dose acyclovir (ACV) were tested for ACV resistance. Patients with proven ACV resistance were treated either topically with cidofovir solution and gel or with topical foscavir cream or with intravenous foscavir. Results: Among 214 consecutive HCT patients, 6 developed severe ACVr HSV-1 stomatitis (WHO grade III n = 1, WHO grade IV n = 5). All 6 patients suffered from relapse of acute myeloid leukemia (AML) after HCT. ACVr stomatitis was treated topically with first-line (n = 4) or second-line (n = 2) cidofovir. Topical foscavir cream was applied as first-line (n = 1) or second-line (n = 1) therapy. Intravenous foscavir was used in 3 patients (first-line therapy, n = 1; second-line therapy, n = 2). Complete remission was reached by topical cidofovir (n = 3), topical foscavir (n = 1), and intravenous foscavir (n = 1), respectively. Five of the 6 patients died due to progression of leukemia. Only 1 patient survived. Conclusions: ACVr HSV-1 stomatitis is a severe complication in AML patients relapsing after HCT. It reflects the seriously impaired general condition of these patients. This analysis shows that topical treatment with cidofovir or foscavir might be a sufficient first-line therapy approach in ACVr HSV-1 stomatitis. It might serve as a less toxic alternative to intravenous foscavir.

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Section: Discussion/conclusionmentioning

confidence: 99%

Topical Treatment of Acyclovir-Resistant Herpes Simplex Virus Stomatitis after Allogeneic Hematopoietic Cell Transplantation

Heidenreich¹,

Kreil²,

Mueller³

et al. 2020

Oncol Res Treat

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“…Topical viral infections such as HPV have been reported on bilateral hand transplants, either latent in the donor at the time of procurement or acquired posttransplant, and have been treated with topical cidofovir [35,36]. Topical cidofovir has also proven to be useful in cutaneous HSV cases in VCA transplant patients that, under the influence of immunosuppression and repeated treatment, have become drug-resistant or particularly refractory to treatment [37,38].…”

Section: Skinmentioning

confidence: 99%

“…Ganciclovir and valganciclovir, used for CMV prophylaxis, also have activity against HSV and are protective. Topical cidofovir is also available for reactivated or primary cutaneous cases that become drug-resistant or particularly refractory to treatment [37,38].…”

Section: Nervementioning

confidence: 99%

Vascular Composite Allografts (VCA): New Transplants, New Infections

Steinbrink

Pruett

Cendales

2020

Emerging Transplant Infections

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Vascularized composite allografts, or VCA transplants, are allotransplants that incorporate multiple tissues transplanted as a single functional unit, most commonly hands or face. They are, by definition, transplants aimed at improving quality of life rather than life sparing. Yet they may also be life-giving in the case of temporary uterine transplants, where the goal is to carry a healthy pregnancy through to term and delivery. Because of the multiple tissue layers involved and the systemic immunosuppression required to prevent rejection, VCA transplants carry unique infection risks, distinct for each tissue in VCA. By understanding the different infectious risks carried by different tissues, this chapter builds a framework to understand and evaluate infection of any vascularized composite allograft.

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“…1 Infections caused by human herpes viruses (HHV), such as © 2021 Special Care Dentistry Association and Wiley Periodicals LLC herpes simplex viruses (HSV) 1 and 2 and cytomegalovirus (CMV or HHV-5), may reactivate during the immunosuppression period associated with HSCT. [2][3] HSV infection usually occurs in oral and perioral regions and is associated with high morbidity and mortality in patients with malignant hematological diseases. 2,4 HSV-1 and -2 reactivations are serious post-HSCT complications.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3] HSV infection usually occurs in oral and perioral regions and is associated with high morbidity and mortality in patients with malignant hematological diseases. 2,4 HSV-1 and -2 reactivations are serious post-HSCT complications. HSV-1 is associated with oral infections, whereas HSV-2 usually causes genital lesions, with oral lesions being rare.…”

Section: Introductionmentioning

confidence: 99%

Atypical oral viral coinfection after allogeneic hematopoietic stem cell transplantation: Diagnosis and treatment challenge

Schepanski

Machado

Sola

et al. 2021

Special Care in Dentistry

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Background: Viral reactivation in patients undergoing immunosuppressive therapy after hematopoietic stem cell transplantation (HSCT) is a serious complication associated with significant morbidity and mortality. Infections caused by human herpes viruses such as herpes simplex virus (HSV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) can result in oral lesions. Case Presentation: A 40-year-old male patient who had undergone HSCT presented with ulcerated lesions in different areas of the mouth, for 7 months. The lesions had evolved to painful exophytic nodules with an erythematous, ulcerated surface. They were present on the tongue margins and soft and hard palate.Histological, immunohistochemical (IHC), and polymerase chain reaction analyses were performed, and the results were compatible with HSV-1 and -2 and CMV infections. Treatment comprised five sessions of antimicrobial photodynamic therapy (aPDT) and oral valganciclovir. Thirty days after combined antiviral therapy and aPDT, the lesions were completely resolved. Patient was followed up for 12 months without recurrence. Conclusion:Diagnosis and treatment of atypical oral infections in immunosuppressed patients is challenging. Assessment of both clinical and laboratory findings is mandatory for a conclusive diagnosis. The use of local antimicrobial and systemic therapies contributes to positive clinical response in such cases.

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Complex management of resistant oral herpes simplex virus infection following hematopoietic stem cell transplantation: potential role of topical cidofovir

Abstract: Topical cidofovir can provide effective management of symptomatic oropharyngeal HSV while reducing risk of systemic toxicity and drug interaction and represents an additional approach to management for management in medically compromised patients.

Cited by 12 publications

References 18 publications

Topical Treatment of Acyclovir-Resistant Herpes Simplex Virus Stomatitis after Allogeneic Hematopoietic Cell Transplantation

Topical Treatment of Acyclovir-Resistant Herpes Simplex Virus Stomatitis after Allogeneic Hematopoietic Cell Transplantation

Vascular Composite Allografts (VCA): New Transplants, New Infections

Atypical oral viral coinfection after allogeneic hematopoietic stem cell transplantation: Diagnosis and treatment challenge

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