title: How I treat HHV8/KSHV-related diseases in posttransplant patients.
abstract: Posttransplantation human herpesvirus-8 (HHV8)/Kaposi sarcoma herpesvirus (KSHV) primary infection and/or reactivations are associated with uncommon and sometimes fatal, neoplastic, and non-neoplastic diseases. HHV8-related clinical manifestations notably range from Kaposi sarcoma (KS) to either primary effusion lymphoma or multicentric Castleman disease B-cell malignancies, and from polyclonal HHV8-positive plasmacytic lymphoproliferative disorders to bone marrow failure and peripheral cytopenias, associated or not with hemophagocytic syndromes, and to acute hepatitis syndromes. We reviewed the patient series reported in the literature and summarized clinical management aspects, in terms of diagnosis, follow-up, and treatment. We described typical clinical presentations and histopathologic diagnostic features of these diseases, and we discussed the role of HHV8-specific serologic, molecular, and immunologic assays, particularly focusing on recent data from HHV8-specific T-cell monitoring in posttransplantation KS patients. We finally discussed actual therapeutic options, namely, the reduction or discontinuation of immunosuppressive therapy or the switch from calcineurin inhibitors to mTOR inhibitors, as alternatives to antineoplastic chemotherapy, along with the use of antiherpesvirus agents as prophylactic or therapeutic measures, and treatment with rituximab in posttrans-plantation multicentric Castleman disease patients and non-neoplastic HHV8-associated syndromes.
authors.affiliation: Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università di Modena e Reggio Emilia, UO-C Ematologia, AOU Policlinico, Modena 41124, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Riva
authors.forename: Mario
authors.initials: M
authors.lastname: Luppi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Barozzi
authors.forename: Fabio
authors.initials: F
authors.lastname: Forghieri
authors.forename: Leonardo
authors.initials: L
authors.lastname: Potenza
mesh_terms: D018943:Anthracyclines / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D005871:Castleman Disease / Q000188:drug therapy / Q000209:etiology / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D019468:Disease Management; D005544:Forecasting; D006525:Hepatitis, Viral, Human / Q000188:drug therapy / Q000209:etiology / Q000821:virology; D006566:Herpesviridae Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000635:transmission / Q000821:virology; D019288:Herpesvirus 8, Human / Q000302:isolation & purification / Q000472:pathogenicity*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D051359:Lymphohistiocytosis, Hemophagocytic / Q000188:drug therapy / Q000209:etiology / Q000821:virology; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000209:etiology / Q000821:virology; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000821:virology; D000069283:Rituximab; D012514:Sarcoma, Kaposi / Q000188:drug therapy / Q000209:etiology / Q000821:virology; D014180:Transplantation / Q000009:adverse effects*; D019737:Transplants / Q000821:virology; D014775:Virus Activation
chemical_list: D018943:Anthracyclines; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D000998:Antiviral Agents; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D000069283:Rituximab; C502936:tocilizumab