How I treat HHV8/KSHV-related diseases in posttransplant patients.

摘要

Posttransplantation human herpesvirus-8 (HHV8)/Kaposi sarcoma herpesvirus (KSHV) \udprimary infection and/or reactivations are associated with uncommon and sometimes\udfatal, neoplastic, and non-neoplastic diseases. HHV8-related clinical\udmanifestations notably range from Kaposi sarcoma (KS) to either primary effusion \udlymphoma or multicentric Castleman disease B-cell malignancies, and from\udpolyclonal HHV8-positive plasmacytic lymphoproliferative disorders to bone marrow\udfailure and peripheral cytopenias, associated or not with hemophagocytic\udsyndromes, and to acute hepatitis syndromes. We reviewed the patient series\udreported in the literature and summarized clinical management aspects, in terms\udof diagnosis, follow-up, and treatment. We described typical clinical\udpresentations and histopathologic diagnostic features of these diseases, and we\uddiscussed the role of HHV8-specific serologic, molecular, and immunologic assays,\udparticularly focusing on recent data from HHV8-specific T-cell monitoring in\udposttransplantation KS patients. We finally discussed actual therapeutic options,\udnamely, the reduction or discontinuation of immunosuppressive therapy or the\udswitch from calcineurin inhibitors to mTOR inhibitors, as alternatives to\udantineoplastic chemotherapy, along with the use of antiherpesvirus agents as\udprophylactic or therapeutic measures, and treatment with rituximab in\udposttrans-plantation multicentric Castleman disease patients and non-neoplastic\udHHV8-associated syndromes.