title: Prophylactic role of long-term ultra-low-dose acyclovir for varicella zoster virus disease after allogeneic hematopoietic stem cell transplantation.
abstract: OBJECTIVE
  To evaluate the prophylactic role of long-term ultra-low-dose acyclovir for varicella zoster virus (VZV) disease after allogeneic hematopoietic stem cell transplantation (HSCT).
  
  
  METHODS
  We evaluated 141 patients who were planned to receive acyclovir at 200mg/day until the end of immunosuppressive therapy and for at least 1 year after HSCT in our center between June 2007 and June 2012.
  
  
  RESULTS
  The cumulative incidence of VZV disease after HSCT was 4.5% at 1 year and 18.3% at 2 years. Protocol violation was the only independent significant factor that increased the incidence of VZV disease (hazard ratio (HR) 7.50, 95% confidence interval (CI) 3.60-15.63). Excluding patients with protocol violation, the discontinuation of acyclovir was the only significant factor for the development of VZV disease (HR 5.90, 95% CI 1.56-22.37). Six patients experienced breakthrough VZV disease, but four of these six had not taken acyclovir for several weeks before breakthrough VZV disease. On the other hand, the cumulative incidence of VZV disease after the cessation of acyclovir was 28.4% at 1 year and 38.0% at 2 years. The proportion of disseminated VZV disease was only 7% and no patient died directly of VZV disease.
  
  
  CONCLUSIONS
  This study shows that long-term ultra-low-dose acyclovir appears to be effective for preventing VZV disease, especially disseminated VZV disease, after allogeneic HSCT. We recommend continuing acyclovir until the end of immunosuppressive therapy and for at least 1 year after HSCT, but additional strategies such as the administration of varicella vaccine may be needed to eradicate VZV disease.
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kawamura
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Wada
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Yamasaki
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ishihara
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Kana
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ashizawa
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Sato
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Tomohito
authors.initials: T
authors.lastname: Machishima
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Kiriko
authors.initials: K
authors.lastname: Terasako
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Shun-Ichi
authors.initials: S
authors.lastname: Kimura
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Misato
authors.initials: M
authors.lastname: Kikuchi
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakasone
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Yamazaki
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Kanda
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kako
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Aki
authors.initials: A
authors.lastname: Tanihara
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Nishida
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan. Electronic address: ycanda-tky@umin.ac.jp.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006562:Herpes Zoster / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000276:immunology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous / Q000009:adverse effects; D014775:Virus Activation; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir
keywords: Allogeneic hematopoietic stem cell transplantation; Disseminated VZV disease; Long-term acyclovir; Varicella zoster virus disease