Risk stratification and proposal for an antiviral and antibiotic prophylaxis for patients undergoing ruxolitinib therapy
| Proposed test . | Time of analysis . | Result . | Proposed prophylaxis . |
|---|---|---|---|
| CMV IgG, IgM | Prior to ruxolitinib | IgG+, IgM− | No general prophylaxis recommended; CMV PCR every 3 months |
| EBV IgG, IgM | Prior to ruxolitinib | IgG+, IgM− | No general prophylaxis recommended; EBV PCR every 3 months |
| VZV IgG, IgM | Prior to ruxolitinib | IgG+, IgM− | Prophylactic aciclovir 400 mg twice daily* |
| HSV IgG, IgM | Prior to ruxolitinib | IgG+, IgM− | Prophylactic aciclovir 400 mg twice daily* |
| Toxoplasma gondii IgG, IgM | Prior to ruxolitinib | IgG+, IgM− | Co-trimoxazol 800/160 mg 1-0-0 per day* (3 times weekly) |
| Pneumocystis jirovecii | No prophylactic screening | No general prophylaxis recommended; treatment in case of infection | |
| Hepatitis B | Prior to ruxolitinib; monthly HBV DNA screening while on treatment | HBsAg+ | Lamivudine 100 mg per day* |
| Hepatitis C | Prior to ruxolitinib; in case of recent hepatitis C or IgG positivity, monthly screening of HCV DNA while on treatment | HCV−, IgG+ | No prophylaxis recommended or available |
| Mycobacterium tuberculosis | Prior to ruxolitinib | QuantiFERON test+ | Isoniazid 300 mg per day |
| Urogenital and bronchopulmonary infections | Continuous awareness | Ciprofloxacin 500 mg twice daily* as long as white blood cell count <1 × 109/L |
| Proposed test . | Time of analysis . | Result . | Proposed prophylaxis . |
|---|---|---|---|
| CMV IgG, IgM | Prior to ruxolitinib | IgG+, IgM− | No general prophylaxis recommended; CMV PCR every 3 months |
| EBV IgG, IgM | Prior to ruxolitinib | IgG+, IgM− | No general prophylaxis recommended; EBV PCR every 3 months |
| VZV IgG, IgM | Prior to ruxolitinib | IgG+, IgM− | Prophylactic aciclovir 400 mg twice daily* |
| HSV IgG, IgM | Prior to ruxolitinib | IgG+, IgM− | Prophylactic aciclovir 400 mg twice daily* |
| Toxoplasma gondii IgG, IgM | Prior to ruxolitinib | IgG+, IgM− | Co-trimoxazol 800/160 mg 1-0-0 per day* (3 times weekly) |
| Pneumocystis jirovecii | No prophylactic screening | No general prophylaxis recommended; treatment in case of infection | |
| Hepatitis B | Prior to ruxolitinib; monthly HBV DNA screening while on treatment | HBsAg+ | Lamivudine 100 mg per day* |
| Hepatitis C | Prior to ruxolitinib; in case of recent hepatitis C or IgG positivity, monthly screening of HCV DNA while on treatment | HCV−, IgG+ | No prophylaxis recommended or available |
| Mycobacterium tuberculosis | Prior to ruxolitinib | QuantiFERON test+ | Isoniazid 300 mg per day |
| Urogenital and bronchopulmonary infections | Continuous awareness | Ciprofloxacin 500 mg twice daily* as long as white blood cell count <1 × 109/L |
In the case of an active infection, initial therapeutic antiviral or antibiotic treatment is required, followed by the appropriate prophylactic therapy.
CMV, cytomegalovirus; EBV, Epstein-Barr virus; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; HCV, hepatitis C virus; HSV, herpes simplex virus; IgG, immunoglobulin G; PCR, polymerase chain reaction; VZV, varicella zoster virus.
According to renal function/glomerular filtration rate and to antibiotic resistance testing, respectively.