Oshima, K., Takahashi, T., Mori, T., Matsuyama, T., Usuki, K., Asano-Mori, Y., . . . Kanda, Y. (2010). One-year low-dose valacyclovir as prophylaxis for varicella zoster virus disease after allogeneic hematopoietic stem cell transplantation. A prospective study of the Japan Hematology and Oncology Clinical Study Group. Transplant Infectious Disease, 12, 421–427.
To determine the cumulative incidence of varicella-zoster virus (VZV) two years after transplant.
Following allogeneic hematopoietic stem cell transplant (HSCT), patients received low-dose valacyclovir (VCV) for prophylaxis against VZV. Up to day 35, patients received oral acyclovir (ACV) 1,000 mg/day, and then from days 36 to 365, they received oral VCV 500 mg/day three days a week. Patients were monitored for VZV for two years after HSCT.
This was a prospective, nonrandomized study.
Breakthrough VZV occurred in two patients while receiving VCV. After stopping VCV prophylaxis, an additional five patients developed VZV disease. These seven patients had a favorable response to oral or intravenous VCV given at therapeutic doses. Univariate analysis revealed no factors that significantly associated patients with incidence of VZV.
For patients undergoing allogeneic HSCT, one year of low-dose VCV is safe and effective for preventing VZV.
Small sample size
Patients undergoing allogeneic HSCT may benefit from the safe use of low-dose prophylactic VCV (500 mg/day three times a week) for VZV in the posttransplant setting.