Acyclovir prophylaxis against varicella zoster virus reactivation in multiple myeloma patients treated with bortezomib-based therapies: a retrospective analysis of 100 patients.
BACKGROUND
Previous studies have indicated that, in patients with multiple myeloma (MM), bortezomib is associated with an increased incidence of herpes zoster, resulting from reactivation of latent varicella zoster virus (VZV).


OBJECTIVE
Our objective was to determine whether increased risk of VZV reactivation could be abrogated by using prophylactic acyclovir.


METHODS
We retrospectively evaluated 100 consecutive MM patients treated with bortezomib-based therapies at the Roswell Park Cancer Institute for development of herpes zoster. Frontline and relapsed/refractory patients were included, and patients received bortezomib alone or in combination with agents such as doxorubicin, melphalan, or dexamethasone. All patients received >4 weeks of acyclovir prophylaxis (400 mg twice daily), which was initiated prior to starting treatment with bortezomib and discontinued 4 weeks following bortezomib.


RESULTS
Median patient age was 62 years, 57% were male, and most (56%) had Durie-Salmon stage IIIA MM. None of the 100 MM patients receiving acyclovir prophylaxis developed herpes zoster during treatment with bortezomib, irrespective of patients receiving a wide variety of concomitant antimyeloma therapies and regardless of response to bortezomib-based therapy. One additional patient, found to be noncompliant with acyclovir therapy, experienced VZV reactivation, having received 3 cycles of bortezomib (3 weeks each cycle) in combination with cyclophosphamide and dexamethasone.


CONCLUSIONS
Limitations of the study include its small size and retrospective nature.


CONCLUSIONS
The increased risk of VZV reactivation observed in previous studies of bortezomib-based therapy was completely abrogated in this series of patients who received prophylaxis with acyclovir.
Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA.
Abhisek
A
Swaika
Aneel
A
Paulus
Kena C
KC
Miller
Taimur
T
Sher
Nikolaos G
NG
Almyroudis
Donna
D
Ball
Margaret
M
Wood
Aisha
A
Masood
Kelvin
K
Lee
Asher A
AA
Chanan-Khan
D000212:Acyclovir / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000998:Antiviral Agents / Q000627:therapeutic use*; D001897:Boronic Acids / Q000009:adverse effects*; D000069286:Bortezomib; D005260:Female; D014645:Herpesvirus 3, Human / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000821:virology; D011719:Pyrazines / Q000009:adverse effects*; D012189:Retrospective Studies; D014775:Virus Activation / Q000187:drug effects*
D000970:Antineoplastic Agents; D000998:Antiviral Agents; D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib; D000212:Acyclovir