# Prevention, diagnosis and management of community acquired respiratory virus infections including COVID-19 in patients with cancer: 2025 updated evidence-based guideline of the infectious diseases working party (AGIHO) of the German society for hematology and medical oncology (DGHO)

**Authors:** Nicola Giesen, Sibylle C. Mellinghoff, Elham Khatamzas, Felix Korell, Marcus Hentrich, Hermann Einsele, Larissa Henze, Claus Peter Heußel, Christian Hohmann, Björn-Erik Ole Jensen, Malte B. Monin, Philippe Schafhausen, Enrico Schalk, Karsten Spiekermann, Sebastian Voigt, Marie von Lilienfeld-Toal, Daniel Teschner, Oliver A. Cornely, Christina Rieger, Elena Busch

PMC · DOI: 10.1007/s00277-026-06769-9 · 2026-01-21

## TL;DR

This paper provides updated guidelines for preventing and managing respiratory virus infections, including COVID-19, in cancer patients.

## Contribution

The paper presents new evidence-based recommendations for CARV and SARS-CoV-2 management in immunocompromised cancer patients.

## Key findings

- SARS-CoV-2 remains a significant threat to cancer patients alongside other respiratory viruses.
- Updated guidelines emphasize prevention and early intervention for optimal patient care.
- Recommendations are based on a systematic review of data up to early 2025.

## Abstract

Community-acquired respiratory viruses (CARV), such as influenza-, parainfluenza- or respiratory syncytial virus, pose a significant threat to immunocompromised patients with cancer. Following the COVID-19 pandemic, SARS-CoV-2 has now joined the ranks of endemic respiratory viruses and continues to be a cause of significant morbidity and mortality in patients with cancer. Strategies to protect this vulnerable patient population both by prevention of infection and by early therapeutic intervention in case of infectious disease are therefore of utmost importance. This guideline provides updated evidence-based recommendations on diagnosis, prophylaxis and treatment of CARV infections including COVID-19 in patients with solid tumors or hematologic malignancies to support clinicians in offering optimal care. The guideline is based on a systematic review of currently available data and was developed until the beginning of 2025 by an expert panel of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO).

## Linked entities

- **Diseases:** cancer (MONDO:0004992), influenza (MONDO:0005812), SARS-CoV-2 (MONDO:0100096), COVID-19 (MONDO:0100096)

## Full-text entities

- **Genes:** KRT20 (keratin 20) [NCBI Gene 54474] {aka CD20, CK-20, CK20, K20, KRT21}, CYP3A4 (cytochrome P450 family 3 subfamily A member 4) [NCBI Gene 1576] {aka CP33, CP34, CYP3A, CYP3A3, CYPIIIA3, CYPIIIA4}, IL6R (interleukin 6 receptor) [NCBI Gene 3570] {aka CD126, HIES5, IL-1Ra, IL-6R, IL-6R-1, IL-6RA}, CD38 (CD38 molecule) [NCBI Gene 952] {aka ADPRC 1, ADPRC1, cADPR1}
- **Diseases:** chronic lymphocytic leukaemia (MESH:D015461), multiple myeloma (MESH:D009101), renal insufficiency (MESH:D051437), bacterial (MESH:D001424), hMPV infections (MESH:D007239), bacterial co-infection (MESH:D060085), thromboembolic (MESH:D013923), bleeding (MESH:D006470), venous thromboembolism (MESH:D054556), critical illness (MESH:D016638), Infectious Diseases (MESH:D003141), respiratory (MESH:D012131), Cancer (MESH:D009369), death (MESH:D003643), hypogammaglobulinemia (MESH:D000361), RSV disease (MESH:D012120), LRTD (MESH:D012140), Parainfluenza (MESH:D018184), hematologic malignancies (MESH:D019337), respiratory tract infection (MESH:D012141), viral infections (MESH:D014777), Influenza (MESH:D007251), -SARS-CoV-2 coronavirus infections (MESH:D000086382), adenovirus infections (MESH:D000257), metastatic (MESH:D000092182), lymphatic disorders (MESH:D008206), CARV (MESH:D003147), lymphopenia (MESH:D008231), inflammation (MESH:D007249), bronchiolitis (MESH:D001988), fungal co-infections (MESH:D009181), CARV infection (MESH:D017714)
- **Chemicals:** sarilumab (MESH:C000592401), baricitinib (MESH:C000596027), Molnupiravir (MESH:C000656703), Palivizumab (MESH:D000069455), Baloxavir (MESH:C000628402), heparin (MESH:D006493), Dexamethasone (MESH:D003907), Nirsevimab (MESH:C000709769), AIIt (-), venetoclax (MESH:C579720), oxygen (MESH:D010100), neratinib (MESH:C487932), tixagevimab (MESH:C000714167), tocilizumab (MESH:C502936), Ribavirin (MESH:D012254), cilgavimab (MESH:C000714149), oseltamivir (MESH:D053139), ritonavir (MESH:D019438), zanamivir (MESH:D053243), Cidofovir (MESH:D000077404), remdesivir (MESH:C000606551), nirmatrelvir/ritonavir (MESH:C000719967)
- **Species:** human metapneumovirus (no rank) [taxon 162145], Adenoviridae (family) [taxon 10508], Betapolyomavirus tertihominis (species) [taxon 1891764], Human bocavirus (species) [taxon 329641], Human rhinovirus sp. (species) [taxon 169066], Human coronavirus 229E (no rank) [taxon 11137], Coronaviridae (family) [taxon 11118], WU Polyomavirus (no rank) [taxon 440266], Enterovirus (genus) [taxon 12059], Orthomyxoviridae (family) [taxon 11308], Orthocoronavirinae (subfamily) [taxon 2501931], Gammacoronavirus (genus) [taxon 694013], Severe acute respiratory syndrome coronavirus 2 (no rank) [taxon 2697049], Respiratory syncytial virus (no rank) [taxon 12814], Homo sapiens (human, species) [taxon 9606]
- **Mutations:** F456L
- **Cell lines:** JN.1 — Homo sapiens (Human), Lung small cell carcinoma, Cancer cell line (CVCL_0C15)

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Source: https://tomesphere.com/paper/PMC12823726