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Acyclovir prophylaxis in bone marrow transplant recipients.

G Lundgren, H Wilczek, B Lönnqvist

    Scandinavian Journal of Infectious Diseases. Supplementum
    |January 1, 1985
    PubMed
    Summary

    Prolonged acyclovir prophylaxis significantly reduced herpes simplex virus (HSV) and varicella zoster virus (VZV) infections in bone marrow transplant patients. Acyclovir demonstrated high efficacy and safety, with minimal adverse effects observed during long-term use.

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    Area of Science:

    • Virology
    • Immunology
    • Hematology
    • Oncology

    Background:

    • Bone marrow transplantation (BMT) patients are at high risk for opportunistic viral infections, particularly from herpesviruses.
    • Reactivation of latent herpes simplex virus (HSV) and varicella zoster virus (VZV) poses a significant threat post-BMT.
    • Effective antiviral prophylaxis is crucial to improve outcomes in immunocompromised BMT recipients.

    Purpose of the Study:

    • To evaluate the efficacy and safety of prolonged acyclovir prophylaxis in preventing herpesvirus infections after bone marrow transplantation.
    • To assess the impact of acyclovir on the incidence of HSV and VZV reactivation in BMT patients.
    • To determine the safety profile of long-term acyclovir administration in this patient population.

    Main Methods:

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    • A randomized, double-blind, placebo-controlled trial involving 42 bone marrow transplant patients.
    • Patients received either intravenous acyclovir (250 mg/m2 twice daily) followed by oral acyclovir or placebo, starting 5 days pre-transplant and continuing for 6 months.
    • Viral infections, including HSV and VZV, were monitored throughout the study period.

    Main Results:

    • Acyclovir prophylaxis significantly reduced the incidence of HSV infections (1 episode vs. 10 episodes in placebo group, p=0.0002) and herpes zoster (0 vs. 5 patients, p=0.0017).
    • The majority of HSV infections in the placebo group occurred in patients with high pre-transplant HSV IgG titers (>10,000 ELISA).
    • Acyclovir did not demonstrate efficacy against cytomegalovirus (CMV) infections or impact engraftment time or graft-versus-host disease (GVHD); adverse reactions were minimal.

    Conclusions:

    • Prolonged acyclovir prophylaxis is highly effective and safe for preventing HSV and VZV reactivation in bone marrow transplant recipients.
    • The drug significantly lowers the risk of herpesvirus-related morbidity in this vulnerable population.
    • Acyclovir's efficacy is linked to controlling reactivations, particularly in patients with pre-existing high antibody titers to HSV.