title: Varicella-zoster virus prophylaxis with low-dose acyclovir in patients with multiple myeloma treated with bortezomib.
abstract: BACKGROUND
  Varicella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.
  
  
  METHODS
  We studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m2 was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.
  
  
  RESULTS
  A total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.
  
  
  CONCLUSIONS
  Varicellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.
authors.affiliation: Department of Internal Medicine-Hematooncology, University Hospital Brno, Masaryk University, Brno, Czech Republic. lpour@fnbrno.cz
authors.forename: Ludek
authors.initials: L
authors.lastname: Pour
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Adam
authors.forename: Lucie
authors.initials: L
authors.lastname: Buresova
authors.forename: Marta
authors.initials: M
authors.lastname: Krejci
authors.forename: Andrea
authors.initials: A
authors.lastname: Krivanova
authors.forename: Viera
authors.initials: V
authors.lastname: Sandecka
authors.forename: Lenka
authors.initials: L
authors.lastname: Zahradova
authors.forename: Tomas
authors.initials: T
authors.lastname: Buchler
authors.forename: Jiri
authors.initials: J
authors.lastname: Vorlicek
authors.forename: Roman
authors.initials: R
authors.lastname: Hajek
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use; D001897:Boronic Acids / Q000009:adverse effects / Q000627:therapeutic use*; D000069286:Bortezomib; D005260:Female; D006562:Herpes Zoster / Q000517:prevention & control*; D014645:Herpesvirus 3, Human / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000821:virology*; D011446:Prospective Studies; D011719:Pyrazines / Q000009:adverse effects / Q000627:therapeutic use*; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib; D000212:Acyclovir