Viral Infections in Individuals with Acute Myeloid Leukemia – MD Magazine

 
 
Yoav Golan, MD, MS, FIDSA, attending physician and associate professor of medicine at Tufts University School of Medicine, Boston, MA, discusses common viruses that could reactivate in patients along with acute myeloid leukemia (AML), highlighting that preventative procedures that must be taken.
 
Among the pathogens that can easily figure out the outcome of AML treatment are viruses. Viruses are abundant in the environment and are frequently carried in our body. Immunocompromising agents that we usage to address AML not just boost the risk of bacterial and fungal infections, however additionally viral infections, particularly those viruses that are carried in our physique or that infected us in the past.
 
The many common viruses to induce trouble in AML patients belong to the herpes family of viruses, mostly Human herpes virus 1 (HHV1), chicken pox virus (or varicella zoster virus (VZV), and cytomegalovirus (CMV). While many patients that make AML and undergo therapy have actually been exposed to the chicken pox virus in their childhood or received vaccination versus chicken pox, several are colonized and carry the herpes virus that often triggers cold sores in people that are not immunocompromised. And concerning 50% to 60% of adults have actually additionally been infected by CMV in the past and go on to carry this virus as well.
 
The usage of immunosuppressive therapy also as the ailment itself are significant risk factors for reactivation of those viruses which means that those viruses gone their immune manage and can easily begin replicating and causing disease. ailment caused by those viruses pretty frequently is pretty various from ailment caused by the very same viruses in immune-competent patients due to the lack of immune control.
 
So, for example, Herpes simplex virus that often triggers cold sores in others people can easily induce disseminated herpes ailment that can easily affect several internal organs, particularly the liver and others, and can easily be lethal in several of the patients that make it. An additional example is CMV that can easily reactivate in a patient that is immunocompromised and induce multi-organ ailment that entails the eyes, lungs, bone marrow, and kidneys. Reactivation of those viruses is not infrequent in our patients.
 
The very first step in preventing those infections is adequately classifying the patient as being at risk by performing a couple of blood examinations to consider serologies for HHV 1, others herpes viruses, antibodies to VZV, and antibodies to CMV. Those patients that have actually been infected and have actually favorable antibodies must get antiviral prophylaxis. It was revealed that antiviral prophylaxis in those patients will certainly lower the risk of infections by herpes viruses. The choice of antiviral prophylaxis varies from one focus to the others along with the many often used agents including acyclovir, valacyclovir, and Famvir as well.
 
Antiviral prophylaxis is normally offered beginning at the start of neutropenia and followed all of the method to the end of neutropenia, and in those patients along with personal risk factors such as serious mucositis or being on immunosuppressive agents such as steroids for a pretty long period of time, antiviral prophylaxis must be longer and cover this vulnerability period as well.
 
As we mentioned, CMV is really among the viruses that could be pretty problematic in immunocompromised patients, particularly in AML patients and patients undergoing bone marrow transplantation. among the problems in preventing CMV ailment is that the many efficient agents, ganciclovir and valganciclovir, are additionally potent suppressors of the bone marrow.
 
One of the parameters that figure out the outcome in patients along with AML undergoing chemotherapy and those that grab a bone marrow transplant is their ability to engraft and resolve their neutropenia. Obviously, ganciclovir and valganciclovir can easily interfere along with that. For those reasons, those agents are now frequently used as standard prophylaxis for CMV.