title: Daily 500 mg valacyclovir is effective for prevention of Varicella zoster virus reactivation in patients with multiple myeloma treated with bortezomib.
abstract: BACKGROUND
  In patients with multiple myeloma (MM), bortezomib is associated with a significant risk of Varicella zoster virus (VZV) reactivation. There are some reports that acyclovir reduces the risk of VZV reactivation. We assessed whether VZV reactivation could be reduced by using prophylactic valacyclovir at a dose of 500 mg daily.
  
  
  METHODS
  We retrospectively evaluated 32 patients with MM who received bortezomib and valacyclovir prophylaxis at the Kanazawa Medical University Hospital. Patients received valacyclovir prophylaxis orally at a dose of 500 mg daily, without cessation during bortezomib treatment.
  
  
  RESULTS
  The median age was 69 years (range=45-90 years). Fifteen patients were male and seventeen were female. The median bortezomib dose was 37.0 mg/m(2) (range=5.2-167.6 mg/m(2)). All patients also received corticosteroids. The median duration of valacyclovir prophylaxis was 301 days (range=24-1206 days) and the median valacyclovir dose was 150.5 g (range=12-603 g). VZV reactivation developed in only one patient during valacyclovir prophylaxis. VZV reactivation did not develop in three patients who had a past history of VZV reactivation without valacyclovir prophylaxis. Adverse events over grade 3 associated with valacyclovir were not observed.
  
  
  CONCLUSIONS
  Valacyclovir at a dose of 500 mg daily appears to be effective at preventing VZV reactivation and was well-tolerated by patients with MM who received bortezomib.
authors.affiliation: Department of Hematology and Immunology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan. tfukus@kanazawa-med.ac.jp
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukushima
authors.forename: Tomomi
authors.initials: T
authors.lastname: Sato
authors.forename: Takuji
authors.initials: T
authors.lastname: Nakamura
authors.forename: Haruka
authors.initials: H
authors.lastname: Iwao
authors.forename: Akio
authors.initials: A
authors.lastname: Nakajima
authors.forename: Miyuki
authors.initials: M
authors.lastname: Miki
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Sakai
authors.forename: Takafumi
authors.initials: T
authors.lastname: Kawanami
authors.forename: Toshioki
authors.initials: T
authors.lastname: Sawaki
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Fujita
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Masaki
authors.forename: Toshiro
authors.initials: T
authors.lastname: Okazaki
authors.forename: Hideo
authors.initials: H
authors.lastname: Nakajima
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Motoo
authors.forename: Hisanori
authors.initials: H
authors.lastname: Umehara
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D001897:Boronic Acids / Q000627:therapeutic use*; D000069286:Bortezomib; D005260:Female; D006562:Herpes Zoster / Q000517:prevention & control* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000821:virology*; D011719:Pyrazines / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir