Ursu Sorana G, Alhousani Mohammad M, Patrus Gina, Fazal Salman
Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, USA.
Division of Hematology and Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, USA.
Cureus. 2024 Dec 7;16(12):e75270. doi: 10.7759/cureus.75270. eCollection 2024 Dec.
Reactivation of herpes simplex virus (HSV) and varicella zoster virus (VZV) is a potential complication following allogeneic stem cell transplantation (alloSCT). Since different doses and durations of acyclovir prophylaxis may be utilized across transplant centers, this study aimed to evaluate the effectiveness of a lower dose of acyclovir in preventing HSV and VZV reactivation in alloSCT recipients within our institution.
A retrospective chart review was conducted for patients who underwent alloSCT between April 2016 and May 2023. Patients received acyclovir 400 mg orally twice daily as prophylaxis, starting before stem cell infusion and continuing for two years after alloSCT, with ongoing use while on immunosuppressive therapies. Outcomes measured include incidence of HSV and VZV reactivation, timing of viral reactivation, acyclovir-related adverse events, and hospitalizations due to viral reactivation. Pertinent data collected were risk factors for viral reactivation in patients such as immunosuppressive therapies and chemotherapy regimens. Descriptive statistics were used for data analysis.
A total of 246 patients were included in this study. The majority of patients were male with a median age of 60 years (range 20-76) and a diagnosis of acute myeloid leukemia. HSV reactivation occurred in 10 out of the 246 patients (4%) and none had VZV reactivation. The median time to HSV reactivation was 100 days (range 10-1400). No patient had acyclovir-related adverse events such as acute kidney injury, neurotoxicity, or rash. Hospitalization related to HSV reactivation occurred in four of the 10 affected patients (40%).
Oral acyclovir 400 mg taken twice daily for prophylaxis in alloSCT recipients is both effective and well-tolerated. This lower-dose regimen effectively prevents HSV and VZV reactivation without compromising efficacy or patient safety.
单纯疱疹病毒（HSV）和水痘带状疱疹病毒（VZV）再激活是异基因干细胞移植（alloSCT）后的一种潜在并发症。由于不同移植中心可能采用不同剂量和疗程的阿昔洛韦进行预防，本研究旨在评估较低剂量的阿昔洛韦在预防本机构alloSCT受者HSV和VZV再激活方面的有效性。
对2016年4月至2023年5月期间接受alloSCT的患者进行回顾性病历审查。患者在干细胞输注前开始接受阿昔洛韦400mg口服，每日两次作为预防用药，并在alloSCT后持续两年，在接受免疫抑制治疗期间持续使用。测量的结果包括HSV和VZV再激活的发生率、病毒再激活的时间、阿昔洛韦相关不良事件以及因病毒再激活导致的住院情况。收集的相关数据包括患者病毒再激活的危险因素，如免疫抑制治疗和化疗方案。采用描述性统计进行数据分析。
本研究共纳入246例患者。大多数患者为男性，中位年龄60岁（范围20 - 76岁），诊断为急性髓系白血病。246例患者中有10例（4%）发生HSV再激活，无1例发生VZV再激活。HSV再激活的中位时间为100天（范围10 - 1400天）。没有患者出现阿昔洛韦相关的不良事件，如急性肾损伤、神经毒性或皮疹。10例受影响患者中有4例（40%）因HSV再激活而住院。
alloSCT受者每日两次口服400mg阿昔洛韦进行预防既有效又耐受性良好。这种低剂量方案可有效预防HSV和VZV再激活，而不影响疗效或患者安全。
