European guidelines for prevention and management of influenza in hematopoietic stem cell transplantation and leukemia patients: summary of ECIL‐4 (2011), on behalf of ECIL, a joint venture of EBMT, EORTC, ICHS, and ELN

Abstract

Influenza may cause severe disease and mortality in leukemia patients and in hematopoietic stem cell transplantation recipients. The 4th European Conference of Infections in Leukemia (ECIL‐4) has developed evidence‐based guidelines for prevention and management of influenza infections in these patients. Real‐time reverse‐transcription polymerase chain reaction is the diagnostic test of choice, as it is the most sensitive and specific test for influenza. The risks for severe influenza and fatal outcome include lymphopenia, older age, influenza soon after transplantation or chemotherapy, steroid treatment, and lack of early antiviral therapy. Neuraminidase inhibitors (oral oseltamivir or inhalation of zanamivir) are currently the most effective therapeutic agents for influenza. Main preventive measures include annual vaccination of patients, household contacts, and hospital staff. This review summarizes ECIL‐4's main recommendations.

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Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

“…The main viruses include herpes viruses (CMV, HSV, VZV, HHV6) and respiratory viruses such as influenza and adenovirus. [45][46][47][48][49] BK virus is particularly problematic in the context of hemorrhagic cystitis, and EBV with risks of post-transplant lymphoproliferative diseases. The fungal risk is major during the neutropenic phase, especially in the setting of GvHD requiring corticosteroids.…”

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“…Typical symptoms may be absent, while gastrointestinal symptoms (e.g. abdominal pain, nausea, vomiting and diarrhea) may occur [10].…”

“…The latter constitutes the current gold standard due to highest specificity and sensitivity [10]. Other PCR-methods may be indicated in certain situations, e.g.…”

“…Other PCR-methods may be indicated in certain situations, e.g. quantitative PCR to estimate viral load in cases of viral pneumonia in HSCT patients, or detection of gene variants leading to resistance [10]. Single RT-PCRs for the detection of distinct CRV, and commercial multiplex RT-PCR-systems are now available.…”