Long-term low-dose acyclovir against varicella-zoster virus reactivation after allogeneic hematopoietic stem cell transplantation.
To evaluate the efficacy of long-term administration of acyclovir as prophylaxis against varicella-zoster virus (VZV) reactivation, we analyzed the medical records of 86 consecutive adult patients who obtained engraftment after allogeneic hematopoietic stem cell transplantation from January 1996 to March 2000. We started long-term low-dose (400 mg/day) oral administration of acyclovir in June 1999, and this was continued until the end of immunosuppressive therapy after transplantation. There was no breakthrough reactivation of VZV in patients receiving acyclovir. Five patients who were receiving cyclosporine or prednisolone developed VZV reactivation after discontinuing acyclovir. With this prophylaxis, the cumulative incidence of VZV reactivation at 1 year after transplantation decreased from 33% to 10% (P = 0.025). On multivariate analysis, the use of long-term acyclovir was identified as a significant independent parameter for the development of VZV reactivation. These findings suggest the efficacy of long-term prophylaxis with low-dose acyclovir. Resumption of acyclovir upon restarting immunosuppressive therapy might be important for the further prevention of VZV reactivation. The benefit of long-term low-dose acyclovir should be confirmed prospectively.
Kanda
Y
Y
Stem Cell Transplant Unit, National Cancer Center Hospital, University of Tokyo, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Mineishi
S
S
Saito
T
T
Saito
A
A
Yamada
S
S
Ohnishi
M
M
Chizuka
A
A
Niiya
H
H
Suenaga
K
K
Nakai
K
K
Takeuchi
T
T
Makimoto
A
A
Tanosaki
R
R
Kami
M
M
Tanaka
Y
Y
Fujita
S
S
Watanabe
T
T
Kobayashi
Y
Y
Tobinai
K
K
Takaue
Y
Y
D000212:Acyclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016572:Cyclosporine / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006562:Herpes Zoster / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014645:Herpesvirus 3, Human / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007157:Immunologic Surveillance / Q000187:drug effects; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011239:Prednisolone / Q000009:adverse effects*; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects; D014184:Transplantation, Homologous; D014775:Virus Activation / Q000187:drug effects*
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D000212:Acyclovir