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

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.

Herpes zoster after autologous haematopoietic stem cell transplantation without antiviral prophylaxis

“…Only one out of 12 patients (8·3%) without these risk factors experienced HZ following the addition of patients’ age (>56 years) to the risk factors in the present study. The incidence is equivalent to previous studies that used long‐term antiviral prophylaxis or vaccination (Kawamura et al , ; Winston et al , ). In contrast, one patient experienced HZ before engraftment in the clean room (7 days after auto‐HSCT), increasing the risk of outbreak.…”

“…The 1yCI of HZ after auto‐HSCT without antiviral prophylaxis was higher than that in previously reported cases receiving long‐term antiviral prophylaxis (Kawamura et al , ). Furthermore, the 1yCI of HZ in patients with a high number of chemotherapy cycles and a past history of HZ were high (40·6% and 100%, respectively).…”

“…Herpes zoster (HZ) is a common complication of autologous haematopoietic stem cell transplantation (auto‐HSCT) (Lee et al , ). Some studies have demonstrated the efficacy of antiviral prophylaxis during and after auto‐HSCT (Kawamura et al , ), although it is not highly recommended in the guidelines (Tomblyn et al , ). Furthermore, based on the cost‐effectiveness and duration of the treatment, the routine use of prophylaxis remains controversial (Lee et al , ).…”

Effectiveness of acyclovir prophylaxis against varicella zoster virus disease after allogeneic hematopoietic cell transplantation: A systematic review and meta‐analysis

“…Paradoxical finding of high effect size in low–dose acyclovir prophylaxis can be attributable to the large sample size of low–dose groups. A study by Kawamura et al suggested that low–dose acyclovir prophylaxis is effective to prevent VZV disease after HCT. Our results support this conclusion.…”

Duration of Antiviral Prophylaxis and Risk of Herpes Zoster among Patients Receiving Autologous Hematopoietic Stem Cell Transplants: A Retrospective, Observational Study

“…VZV reactivation rate in the 6-month prophylaxis group was 17%, but did not reach statistical significance due to small numbers. Kawamura et al [24] retrospectively reviewed the clinical charts of 105 patients who underwent their first auto-HSCT between September 2007 and June 2014. Patients were divided into three groups according to the timing at which acyclovir prophylaxis was stopped after auto-HSCT: at engraftment, between engraftment and 1 year after auto-HSCT, and later than 1 year.…”