Low-dose acyclovir prophylaxis for the prevention of herpes simplex virus and varicella zoster virus diseases after autologous hematopoietic stem cell transplantation

Int J Hematol. 2015 Aug;102(2):230-7. doi: 10.1007/s12185-015-1810-4. Epub 2015 May 20.

Abstract

Limited data are available on prophylaxis for herpes simplex virus (HSV) and varicella zoster virus (VZV) disease following autologous hematopoietic stem cell transplantation (auto-HCT). We retrospectively reviewed the clinical charts of 105 consecutive patients who underwent their first auto-HCT at our institution between September 2007 and June 2014. Before August 2009, 30 patients received oral acyclovir at 1000 mg/day until engraftment, whereas after September 2009, 69 patients received oral acyclovir at 200 mg/day. After engraftment, acyclovir was continued at 200 mg/day at the discretion of the attending physicians in both groups. The cumulative incidence of HSV disease at 1 year after auto-HCT was 7.7 and 4.5 % in patients who received oral acyclovir at 1000 and 200 mg/day, respectively (P = 0.75). Patients were next divided into three groups according to the timing at which acyclovir prophylaxis was stopped after auto-HCT; at engraftment, between engraftment and 1 year after auto-HCT, and later than 1 year. The cumulative incidence of VZV disease was 25.8, 7.7, and 0.0 % at 1 year, respectively. This study suggests that low-dose acyclovir prophylaxis may be effective for preventing HSV and VZV disease after auto-HCT. Our findings support the recommendation of acyclovir prophylaxis within the first year after auto-HCT.

MeSH terms

  • Acyclovir / administration & dosage
  • Acyclovir / therapeutic use*
  • Adolescent
  • Adult
  • Aged
  • Antiviral Agents / administration & dosage
  • Antiviral Agents / therapeutic use*
  • Female
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Herpes Simplex / diagnosis
  • Herpes Simplex / epidemiology
  • Herpes Simplex / prevention & control*
  • Herpes Zoster / diagnosis
  • Herpes Zoster / epidemiology
  • Herpes Zoster / prevention & control*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Patient Outcome Assessment
  • Premedication*
  • Retrospective Studies
  • Risk Factors
  • Transplantation Conditioning / adverse effects
  • Transplantation, Autologous
  • Young Adult

Substances

  • Antiviral Agents
  • Acyclovir