Prophylactic role of long-term ultra-low-dose acyclovir for varicella zoster virus disease after allogeneic hematopoietic stem cell transplantation

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• 作者：Koji Kawamura ; Hidenori Wada ; Ryoko Yamasaki ; Yuko Ishihara ; Kana Sakamoto ; Masahiro Ashizawa ; Miki Sato ; Tomohito Machishima ; Kiriko Terasako ; Shun-ichi Kimura ; Misato Kikuchi ; Hideki Nakasone ; Rie Yamazaki ; Junya K ; a ; Shinichi Kako ; Aki Tanihara ; Junji Nishida ; Yoshinobu K ; a
• 关键词：Long-term acyclovir ; Varicella zoster virus disease ; Allogeneic hematopoietic stem cell transplantation ; Disseminated VZV disease
• 刊名：International Journal of Infectious Diseases
• 出版年：February, 2014
• 年：2014
• 卷：19
• 期：Complete
• 页码：26-32
• 全文大小：586 K

文摘

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Summary

Objectives

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 200 mg/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.