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Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation - a randomized double-blind placebo controlled study.

Author(s): Boeckh M, Kim HW, Flowers ME, Meyers JD, Bowden RA

Affiliation(s): Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA.

Publication date & source: 2005-11-10, Blood., [Epub ahead of print]

VZV infection occurs in 30% of allogeneic hematopoietic cell transplant (HCT) recipients who had a history of VZV infection. A safe and effective prevention strategy has not been established. In a double-blind controlled trial, 77 HCT recipients at risk for VZV reactivation were randomized to acyclovir 800 mg twice daily or placebo given from 1-2 months until 1 year after transplantation. VZV disease at one year was the primary endpoint; VZV disease after discontinuation of prophylaxis, VZV-specific T cell immunity, HSV infection, CMV disease, survival and safety were secondary endpoints. Acyclovir significantly reduced VZV disease at one year after transplantation (hazard ratio [HR] 0.16, 95% confidence interval 0.035-0.74, P=0.006). In the post-intervention observation period, this difference was not statistically significant (2 years: HR 0.52, 95% CI 0.21-1.3; 5 years: HR 0.76, 95% CI 0.36-1.6). There was no statistically significant difference in reconstitution of VZV-specific T helper cell responses, HSV infections, CMV disease, chronic GvHD, and overall survival between the groups. Acyclovir was well tolerated. Post-study VZV disease predominantly occurred in patients with continued need for systemic immunosuppression. In conclusion, acyclovir effectively and safely prevents VZV disease during the first year after HCT. Periods of prophylaxis greater than 12 months may be beneficial for those HCT recipients on continued immune suppression.

Page last updated: 2006-01-31

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