Kanda Y, Mineishi S, Saito T, Saito A, Yamada S, Ohnishi M, Chizuka A, Niiya H, Suenaga K, Nakai K, Takeuchi T, Makimoto A, Tanosaki R, Kami M, Tanaka Y, Fujita S, Watanabe T, Kobayashi Y, Tobinai K, Takaue Y
Stem Cell Transplant Unit, National Cancer Center Hospital, University of Tokyo, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Bone Marrow Transplant. 2001 Oct;28(7):689-92. doi: 10.1038/sj.bmt.1703214.
To evaluate the efficacy of long-term administration of acyclovir as prophylaxis against varicella-zoster virus (VZV) reactivation, we analyzed the medical records of 86 consecutive adult patients who obtained engraftment after allogeneic hematopoietic stem cell transplantation from January 1996 to March 2000. We started long-term low-dose (400 mg/day) oral administration of acyclovir in June 1999, and this was continued until the end of immunosuppressive therapy after transplantation. There was no breakthrough reactivation of VZV in patients receiving acyclovir. Five patients who were receiving cyclosporine or prednisolone developed VZV reactivation after discontinuing acyclovir. With this prophylaxis, the cumulative incidence of VZV reactivation at 1 year after transplantation decreased from 33% to 10% (P = 0.025). On multivariate analysis, the use of long-term acyclovir was identified as a significant independent parameter for the development of VZV reactivation. These findings suggest the efficacy of long-term prophylaxis with low-dose acyclovir. Resumption of acyclovir upon restarting immunosuppressive therapy might be important for the further prevention of VZV reactivation. The benefit of long-term low-dose acyclovir should be confirmed prospectively.
为评估长期服用阿昔洛韦预防水痘带状疱疹病毒（VZV）再激活的疗效，我们分析了1996年1月至2000年3月期间86例接受异基因造血干细胞移植后成功植入的成年患者的病历。我们于1999年6月开始长期口服低剂量（400毫克/天）阿昔洛韦，并持续至移植后免疫抑制治疗结束。接受阿昔洛韦治疗的患者未出现VZV突破性再激活。5例正在接受环孢素或泼尼松龙治疗的患者在停用阿昔洛韦后发生了VZV再激活。通过这种预防措施，移植后1年VZV再激活的累积发生率从33%降至10%（P = 0.025）。多因素分析显示，长期使用阿昔洛韦是VZV再激活发生的一个显著独立参数。这些结果表明低剂量阿昔洛韦长期预防的有效性。重新开始免疫抑制治疗时恢复使用阿昔洛韦可能对进一步预防VZV再激活很重要。长期低剂量阿昔洛韦的益处应通过前瞻性研究加以证实。
