Acyclovir Prophylaxis Against Varicella Zoster Virus Reactivation in Multiple Myeloma Patients Treated With Bortezomib-Based Therapies: A Retrospective Analysis of 100 Patients

Abhisek Swaika, Aneel Paulus, Kena C. Miller, Taimur Sher, Nikolaos G. Almyroudis, Donna Ball, Margaret Wood, Aisha Masood, Kelvin Lee, Asher A Chanan Khan

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: Previous studies have indicated that, in patients with multiple myeloma (MM), bortezomib is associated with an increased incidence of herpes zoster, resulting from reactivation of latent varicella zoster virus (VZV). Objective: Our objective was to determine whether increased risk of VZV reactivation could be abrogated by using prophylactic acyclovir. Methods: We retrospectively evaluated 100 consecutive MM patients treated with bortezomib-based therapies at the Roswell Park Cancer Institute for development of herpes zoster. Frontline and relapsed/refractory patients were included, and patients received bortezomib alone or in combination with agents such as doxorubicin, melphalan, or dexamethasone. All patients received >4 weeks of acyclovir prophylaxis (400 mg twice daily), which was initiated prior to starting treatment with bortezomib and discontinued 4 weeks following bortezomib. Results: Median patient age was 62 years, 57% were male, and most (56%) had Durie-Salmon stage IIIA MM. None of the 100 MM patients receiving acyclovir prophylaxis developed herpes zoster during treatment with bortezomib, irrespective of patients receiving a wide variety of concomitant antimyeloma therapies and regardless of response to bortezomib-based therapy. One additional patient, found to be noncompliant with acyclovir therapy, experienced VZV reactivation, having received 3 cycles of bortezomib (3 weeks each cycle) in combination with cyclophosphamide and dexamethasone. Limitations: Limitations of the study include its small size and retrospective nature. Conclusions: The increased risk of VZV reactivation observed in previous studies of bortezomib-based therapy was completely abrogated in this series of patients who received prophylaxis with acyclovir.

Original languageEnglish (US)
Pages (from-to)155-159
Number of pages5
JournalJournal of Supportive Oncology
Volume10
Issue number4
DOIs
StatePublished - Jul 2012

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Human Herpesvirus 3
Acyclovir
Multiple Myeloma
Herpes Zoster
Therapeutics
Dexamethasone
Bortezomib
Melphalan
Salmon
Doxorubicin
Cyclophosphamide

ASJC Scopus subject areas

  • Oncology
  • Pharmacology (medical)

Cite this

Acyclovir Prophylaxis Against Varicella Zoster Virus Reactivation in Multiple Myeloma Patients Treated With Bortezomib-Based Therapies : A Retrospective Analysis of 100 Patients. / Swaika, Abhisek; Paulus, Aneel; Miller, Kena C.; Sher, Taimur; Almyroudis, Nikolaos G.; Ball, Donna; Wood, Margaret; Masood, Aisha; Lee, Kelvin; Chanan Khan, Asher A.

In: Journal of Supportive Oncology, Vol. 10, No. 4, 07.2012, p. 155-159.

Research output: Contribution to journalArticle

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title = "Acyclovir Prophylaxis Against Varicella Zoster Virus Reactivation in Multiple Myeloma Patients Treated With Bortezomib-Based Therapies: A Retrospective Analysis of 100 Patients",
abstract = "Background: Previous studies have indicated that, in patients with multiple myeloma (MM), bortezomib is associated with an increased incidence of herpes zoster, resulting from reactivation of latent varicella zoster virus (VZV). Objective: Our objective was to determine whether increased risk of VZV reactivation could be abrogated by using prophylactic acyclovir. Methods: We retrospectively evaluated 100 consecutive MM patients treated with bortezomib-based therapies at the Roswell Park Cancer Institute for development of herpes zoster. Frontline and relapsed/refractory patients were included, and patients received bortezomib alone or in combination with agents such as doxorubicin, melphalan, or dexamethasone. All patients received >4 weeks of acyclovir prophylaxis (400 mg twice daily), which was initiated prior to starting treatment with bortezomib and discontinued 4 weeks following bortezomib. Results: Median patient age was 62 years, 57{\%} were male, and most (56{\%}) had Durie-Salmon stage IIIA MM. None of the 100 MM patients receiving acyclovir prophylaxis developed herpes zoster during treatment with bortezomib, irrespective of patients receiving a wide variety of concomitant antimyeloma therapies and regardless of response to bortezomib-based therapy. One additional patient, found to be noncompliant with acyclovir therapy, experienced VZV reactivation, having received 3 cycles of bortezomib (3 weeks each cycle) in combination with cyclophosphamide and dexamethasone. Limitations: Limitations of the study include its small size and retrospective nature. Conclusions: The increased risk of VZV reactivation observed in previous studies of bortezomib-based therapy was completely abrogated in this series of patients who received prophylaxis with acyclovir.",
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AU - Paulus, Aneel

AU - Miller, Kena C.

AU - Sher, Taimur

AU - Almyroudis, Nikolaos G.

AU - Ball, Donna

AU - Wood, Margaret

AU - Masood, Aisha

AU - Lee, Kelvin

AU - Chanan Khan, Asher A

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AB - Background: Previous studies have indicated that, in patients with multiple myeloma (MM), bortezomib is associated with an increased incidence of herpes zoster, resulting from reactivation of latent varicella zoster virus (VZV). Objective: Our objective was to determine whether increased risk of VZV reactivation could be abrogated by using prophylactic acyclovir. Methods: We retrospectively evaluated 100 consecutive MM patients treated with bortezomib-based therapies at the Roswell Park Cancer Institute for development of herpes zoster. Frontline and relapsed/refractory patients were included, and patients received bortezomib alone or in combination with agents such as doxorubicin, melphalan, or dexamethasone. All patients received >4 weeks of acyclovir prophylaxis (400 mg twice daily), which was initiated prior to starting treatment with bortezomib and discontinued 4 weeks following bortezomib. Results: Median patient age was 62 years, 57% were male, and most (56%) had Durie-Salmon stage IIIA MM. None of the 100 MM patients receiving acyclovir prophylaxis developed herpes zoster during treatment with bortezomib, irrespective of patients receiving a wide variety of concomitant antimyeloma therapies and regardless of response to bortezomib-based therapy. One additional patient, found to be noncompliant with acyclovir therapy, experienced VZV reactivation, having received 3 cycles of bortezomib (3 weeks each cycle) in combination with cyclophosphamide and dexamethasone. Limitations: Limitations of the study include its small size and retrospective nature. Conclusions: The increased risk of VZV reactivation observed in previous studies of bortezomib-based therapy was completely abrogated in this series of patients who received prophylaxis with acyclovir.

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