title: Long-term ultra-low-dose acyclovir against varicella-zoster virus reactivation after allogeneic hematopoietic stem cell transplantation.
abstract: To evaluate the efficacy of long-term prophylaxis with ultra-low-dose acyclovir against varicella-zoster virus (VZV) reactivation, we analyzed the records of 242 Japanese adult patients who underwent allogeneic hematopoietic stem cell transplantation for the first time from 1995 to 2006 at our hospital. We started long-term oral acyclovir at 200 mg/day in July 2001. Acyclovir was continued until the end of immunosuppressive therapy and at least 1 year after transplantation. Sixty-six patients developed VZV reactivation at a median of 248 days after HSCT, with a cumulative incidence of 34.7%. Only one breakthrough reactivation occurred during long-term acyclovir, which responded well to therapeutic dose of valacyclovir. The use of long-term acyclovir was the only independent determinant that significantly decreased the overall incidence of VZV reactivation (20% vs. 50%, P < 0.0001). With this prophylaxis, visceral dissemination and serious complications other than post-herpetic neuralgia was completely eliminated, and thereby need for hospitalization was significantly reduced (21% vs. 71%, P = 0.0034). Fifteen of the 57 patients who discontinued acyclovir developed VZV reactivation, with a cumulative incidence of 32.1%. VZV reactivation following discontinuation tended to occur in patients who were receiving immunosuppressive therapy at the cessation of acyclovir. These findings suggested that long-term prophylaxis of ultra-low-dose acyclovir resulted in a successful prevention of severe VZV-related symptoms and death, with a significantly decreased overall incidence of VZV reactivation. Prolongation of prophylactic acyclovir on profound immunosuppression might be important for thorough suppression of VZV reactivation.
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Asano-Mori
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
authors.forename: Kumi
authors.initials: K
authors.lastname: Oshima
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kako
authors.forename: Akihito
authors.initials: A
authors.lastname: Shinohara
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakasone
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sato
authors.forename: Takuro
authors.initials: T
authors.lastname: Watanabe
authors.forename: Noriko
authors.initials: N
authors.lastname: Hosoya
authors.forename: Koji
authors.initials: K
authors.lastname: Izutsu
authors.forename: Takashi
authors.initials: T
authors.lastname: Asai
authors.forename: Akira
authors.initials: A
authors.lastname: Hangaishi
authors.forename: Toru
authors.initials: T
authors.lastname: Motokura
authors.forename: Shigeru
authors.initials: S
authors.lastname: Chiba
authors.forename: Mineo
authors.initials: M
authors.lastname: Kurokawa
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006562:Herpes Zoster / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D014645:Herpesvirus 3, Human / Q000187:drug effects*; D006801:Humans; D007564:Japan; D008297:Male; D011292:Premedication; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir