Acyclovir to prevent reactivation of varicella zoster virus (herpes zoster) in multiple myeloma patients receiving bortezomib therapy.
BACKGROUND
Humoral-mediated as well as cell-mediated immunity is compromised in myeloma patients receiving treatment. Immunocompromised patients are at risk of developing herpes zoster. There is evidence from clinical trials that bortezomib therapy is associated with a significant risk of herpes zoster. It is the authors' clinical policy to administer long-term acyclovir prophylactically to all symptomatic myeloma patients.


METHODS
A retrospective review of the records of 125 myeloma patients who were treated with bortezomib and who also received routine acyclovir prophylaxis at the dose of 400 mg daily in >80% of patients was undertaken. Alternatives, used in <20% of patients, were 200 mg of acyclovir, 250/500 mg of valacyclovir, or 500 mg of famciclovir administered daily. This was accompanied by patient education regarding the importance of compliance with these prophylactic medications.


RESULTS
The duration of bortezomib therapy was 1 to 164 weeks (median, 16 weeks). The total duration of exposure to bortezomib was 4150 weeks (80 patient-years). Except for the occasional missed dose, the self-reported compliance with antiviral prophylaxis was 100%. Not a single episode of herpes zoster was reported during this period. No adverse effects were noted that could be definitely attributed to acyclovir, valacyclovir, or famciclovir.


CONCLUSIONS
Daily acyclovir (or a suitable alternative) appears to be effective at preventing herpes zoster virus in patients with myeloma who are receiving bortezomib, with or without corticosteroids.
Vickrey
Eric
E
Division of Hematology/Oncology, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois 60611, USA.
Allen
Sharon
S
Mehta
Jayesh
J
Singhal
Seema
S
D000212:Acyclovir / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D006562:Herpes Zoster / Q000150:complications / Q000517:prevention & control*; D014645:Herpesvirus 3, Human / Q000187:drug effects; D006801:Humans; D009101:Multiple Myeloma / Q000150:complications*; D011719:Pyrazines / Q000627:therapeutic use*; D012189:Retrospective Studies; D014775:Virus Activation / Q000187:drug effects*
D000970:Antineoplastic Agents; D000998:Antiviral Agents; D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib; D000212:Acyclovir