Prophylactic antivirals may be helpful in prevention of varicella-zoster virus reactivation in myeloma, but are they safe?
OBJECTIVE
Retrospective analysis of two recent multiple myeloma (MM) clinical trials suggested that the use of bortezomib may be associated with an increased incidence of herpes zoster infections. Therefore, prophylactic use of antivirals has been advocated by some authors. This article explores the potential risks and pitfalls linked to routine acyclovir prophylaxis in bortezomib-treated MM.


CONCLUSIONS
use of antivirals can be associated with important nephro- and neurotoxicity. The nephrotoxicity induced by MM itself and its supportive therapies, superimposed to aging and inherent immunosuppression in myeloma, makes the development of renal impairment even more likely. On the other hand, sensory neuropathy is known to occur both during myeloma progression and in the setting of bortezomib therapy. Furthermore, preexisting nephropathy in MM patients can contribute to the occurrence of serious neurologic toxicity with acyclovir.


CONCLUSIONS
long-term acyclovir prophylaxis in MM patients treated with bortezomib may cause severe renal and neurological toxicity. Prevention of these complications can be achieved through either withholding of the antivirals or a very close monitoring of both neurologic status and renal function in this patient population. This highlights the importance of both clinician's and pharmacist's involvement in optimization of myeloma patient care.
Dasanu
Constantin A
CA
Department of Hematology-Oncology, Saint Francis Hospital and Medical Center, Hartford, CT, USA. c_dasanu@yahoo.com
Alexandrescu
Doru T
DT
D000212:Acyclovir / Q000009:adverse effects / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D016903:Drug Monitoring; D006562:Herpes Zoster / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D014645:Herpesvirus 3, Human / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D015994:Incidence; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy; D020258:Neurotoxicity Syndromes; D011719:Pyrazines / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000139:chemically induced; D014775:Virus Activation / Q000187:drug effects*
D000970:Antineoplastic Agents; D000998:Antiviral Agents; D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib; D000212:Acyclovir