Management of herpesvirus reactivations in patients with solid tumours and hematologic malignancies: update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) on herpes simplex virus type 1, herpes simplex virus type 2, and varicella zoster virus

Ann Hematol. 2022 Mar;101(3):491-511. doi: 10.1007/s00277-021-04746-y. Epub 2022 Jan 7.


Clinical reactivations of herpes simplex virus or varicella zoster virus occur frequently among patients with malignancies and manifest particularly as herpes simplex stomatitis in patients with acute leukaemia treated with intensive chemotherapy and as herpes zoster in patients with lymphoma or multiple myeloma. In recent years, knowledge on reactivation rates and clinical manifestations has increased for conventional chemotherapeutics as well as for many new antineoplastic agents. This guideline summarizes current evidence on herpesvirus reactivation in patients with solid tumours and hematological malignancies not undergoing allogeneic or autologous hematopoietic stem cell transplantation or other cellular therapy including diagnostic, prophylactic, and therapeutic aspects. Particularly, strategies of risk adapted pharmacological prophylaxis and vaccination are outlined for different patient groups. This guideline updates the guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) from 2015 "Antiviral prophylaxis in patients with solid tumours and haematological malignancies" focusing on herpes simplex virus and varicella zoster virus.

Keywords: Acyclovir; Antiviral prophylaxis; Hematologic malignancies; Herpes stomatitis; Herpes zoster; Solid tumours.

Publication types

  • Practice Guideline

MeSH terms

  • Acyclovir / therapeutic use
  • Antiviral Agents / therapeutic use
  • Disease Management
  • Germany
  • Hematologic Neoplasms / virology*
  • Herpes Genitalis / diagnosis
  • Herpes Genitalis / prevention & control
  • Herpes Genitalis / therapy*
  • Herpes Simplex / diagnosis
  • Herpes Simplex / prevention & control
  • Herpes Simplex / therapy*
  • Herpesvirus 1, Human / drug effects
  • Herpesvirus 1, Human / isolation & purification
  • Herpesvirus 1, Human / physiology
  • Herpesvirus 2, Human / drug effects
  • Herpesvirus 2, Human / isolation & purification
  • Herpesvirus 2, Human / physiology
  • Herpesvirus 3, Human / drug effects
  • Herpesvirus 3, Human / isolation & purification
  • Herpesvirus 3, Human / physiology
  • Humans
  • Neoplasms / virology*
  • Vaccination
  • Varicella Zoster Virus Infection / diagnosis
  • Varicella Zoster Virus Infection / prevention & control
  • Varicella Zoster Virus Infection / therapy*
  • Virus Activation* / drug effects


  • Antiviral Agents
  • Acyclovir