Infectious Complications After Umbilical Cord Blood Transplantation for Hematological Malignancy

Linder, Kathleen A; McDonald, Philip J; Kauffman, Carol A; Revankar, Sanjay G; Chandrasekar, Pranatharthi H; Miceli, Marisa H

Universal prophylaxis for HSV is a common practice after UCBT, and all 57 patients in our study were on standard-dose acyclovir. Despite appropriate antiviral prophylaxis, we observed 8 episodes of HSV reactivation, 2 of which were severe and led to the patient's death. Acyclovir resistance was confirmed in 1 patient who died of disseminated HSV-1 infection. Acyclovir resistance appears to be more common after HCT, particularly in the setting of T-cell depletion, and may be related to prolonged use of acyclovir for prophylaxis [27, 28] . None of our patients were on high-dose acyclovir, which is used at some centers for antiviral prophylaxis after HCT; this raises the question of whether this prophylaxis strategy might have prevented these fatal herpesvirus infections [29] .