Orlowski Robert Z, Mills Sharon R, Hartley Eric E, Ye Xiaobu, Piantadosi Steven, Ambinder Richard F, Gore Steven D, Miller Carole B
The Sidney Kimmel Comprehensive Cancer Center, Divisions of Hematological Malignancies, Baltimore, Maryland 21287-8985, USA.
Leuk Lymphoma. 2004 Nov;45(11):2215-9. doi: 10.1080/10428190410001733763.
Reactivation of herpes simplex virus is a common event in patients undergoing dose-intensive remission induction or consolidation chemotherapy of acute leukemia, for which either intravenous or oral acyclovir provides effective prophylaxis. This drug's short serum half-life and low oral bioavailability make frequent dosing necessary, however, and we therefore sought to determine if the pro-drug valacyclovir, which has improved bioavailability, could be successfully substituted for this indication. Eighty-one patients with leukemia were randomized to receive either 500 mg or 1,000 mg of valacyclovir orally every 8 h and followed clinically, as well as with serial surveillance cultures. Over a total of 1,979 days on study between the groups, and 380 throat cultures, no documented episodes of herpes simplex reactivation were noted. Valacyclovir was tolerated well with no evident drug-related toxicities. We conclude that valacyclovir at either of the two doses studied can be safely substituted for oral or intravenous acyclovir, and that it provides effective prophylaxis against reactivation of herpes simplex virus in this patient population.
单纯疱疹病毒再激活在接受急性白血病大剂量缓解诱导或巩固化疗的患者中是常见事件，对此静脉注射或口服阿昔洛韦可提供有效的预防措施。然而，该药物血清半衰期短且口服生物利用度低，因此需要频繁给药，所以我们试图确定生物利用度有所提高的前体药物伐昔洛韦是否能成功替代用于此适应症。81例白血病患者被随机分组，每8小时口服500毫克或1000毫克伐昔洛韦，并进行临床随访以及连续监测培养。两组在总共1979天的研究期间以及380次咽喉培养中，均未发现单纯疱疹再激活的记录事件。伐昔洛韦耐受性良好，没有明显的药物相关毒性。我们得出结论，所研究的两种剂量的伐昔洛韦均可安全替代口服或静脉注射阿昔洛韦，并且它能有效预防该患者群体中单纯疱疹病毒的再激活。
