HHV8-related neoplastic and non-neoplastic diseases in posttransplantation patients
| HHV8-related posttreatment diseases . | Clinical presentations and histopathologic features . | Monitoring tests . | Therapeutic options* . |
|---|---|---|---|
| Neoplastic | |||
| KS | Cutaneous or mucosal lesions; visceral involvement; hematologic manifestations. HHV8+ spindle cells; inflammatory infiltrates | HHV8 viral load (Q-PCR): useful; HHV8 T-cell quantitation (ELISPOT): useful | Reduction of IS or switch to SRL (II-3); CHT (liposomal anthracyclines; II-3); antivirals (III) |
| MCD | Lymphadenopathy; systemic inflammatory symptoms. HHV8+ plasmablasts in mantle zone of follicles; vascular hyperplasia | HHV8 viral load (Q-PCR): useful; HHV8 T-cell quantitation (ELISPOT): investigational | Reduction of IS or switch to SRL (III); rituximab (II-3); CHT (CVP, CHOP, R-CHOP) (II-3); antivirals (III) |
| PEL | Pleural, peritoneal, pericardial effusions; HHV8+ plasmablasts with immunoblastic and anaplastic features | HHV8 viral load (Q-PCR): useful; HHV8 T-cell quantitation (ELISPOT): investigational | Reduction of IS (III); CHT (CHOP) (II-3); antivirals (III) |
| Non-neoplastic | |||
| Plasmacytic B-cell proliferation | Polyclonal HHV8+ B-cell proliferations, in lymph nodes and visceral organs; systemic inflammatory symptoms | HHV8 viral load (Q-PCR): useful (also for diagnosis) | Reduction of IS (III); rituximab (III); antivirals (III) |
| BM failure | Acute bone marrow failure, often with plasmacytosis and signs of HPS; hepatosplenomegaly and severe pancytopenia; systemic inflammatory symptoms; skin maculopapular rash | HHV8 viral load (Q-PCR): useful (also for diagnosis) | Reduction of IS (III); rituximab (III); antivirals (III) |
| Hepatitis | Elevated liver enzymes; systemic inflammatory symptoms; skin maculopapular rash | HHV8 viral load (Q-PCR): useful (also for diagnosis) | Reduction of IS (III); antivirals (III) |
| HHV8-related posttreatment diseases . | Clinical presentations and histopathologic features . | Monitoring tests . | Therapeutic options* . |
|---|---|---|---|
| Neoplastic | |||
| KS | Cutaneous or mucosal lesions; visceral involvement; hematologic manifestations. HHV8+ spindle cells; inflammatory infiltrates | HHV8 viral load (Q-PCR): useful; HHV8 T-cell quantitation (ELISPOT): useful | Reduction of IS or switch to SRL (II-3); CHT (liposomal anthracyclines; II-3); antivirals (III) |
| MCD | Lymphadenopathy; systemic inflammatory symptoms. HHV8+ plasmablasts in mantle zone of follicles; vascular hyperplasia | HHV8 viral load (Q-PCR): useful; HHV8 T-cell quantitation (ELISPOT): investigational | Reduction of IS or switch to SRL (III); rituximab (II-3); CHT (CVP, CHOP, R-CHOP) (II-3); antivirals (III) |
| PEL | Pleural, peritoneal, pericardial effusions; HHV8+ plasmablasts with immunoblastic and anaplastic features | HHV8 viral load (Q-PCR): useful; HHV8 T-cell quantitation (ELISPOT): investigational | Reduction of IS (III); CHT (CHOP) (II-3); antivirals (III) |
| Non-neoplastic | |||
| Plasmacytic B-cell proliferation | Polyclonal HHV8+ B-cell proliferations, in lymph nodes and visceral organs; systemic inflammatory symptoms | HHV8 viral load (Q-PCR): useful (also for diagnosis) | Reduction of IS (III); rituximab (III); antivirals (III) |
| BM failure | Acute bone marrow failure, often with plasmacytosis and signs of HPS; hepatosplenomegaly and severe pancytopenia; systemic inflammatory symptoms; skin maculopapular rash | HHV8 viral load (Q-PCR): useful (also for diagnosis) | Reduction of IS (III); rituximab (III); antivirals (III) |
| Hepatitis | Elevated liver enzymes; systemic inflammatory symptoms; skin maculopapular rash | HHV8 viral load (Q-PCR): useful (also for diagnosis) | Reduction of IS (III); antivirals (III) |
Q-PCR indicates quantitative polymerase chain reaction; ELISPOT, enzyme-linked immunospot; IS, immunosuppression; SRL, sirolimus; and CHT, chemotherapy.
Levels of evidence (according to the US Preventive Services Task Force system) for therapeutic options are reported in parentheses.