Long-term low-dose acyclovir against varicella-zoster virus reactivation after allogeneic hematopoietic stem cell transplantation
Long-term low-dose acyclovir against varicella-zoster virus reactivation after allogeneic hematopoietic stem cell transplantation
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DOI：
10.1038/sj.bmt.1703214
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发表时间：
2001-10-01
影响因子：
4.8
通讯作者：
Takaue, Y
中科院分区：
文献类型：
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作者：
Kanda, Y;Mineishi, S;Takaue, Y
为了评价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月间86例异基因造血干细胞移植后获得植入的连续成人患者的病历。我们于1999年6月开始长期低剂量（400 mg/天）口服无环鸟苷，并持续到移植后免疫抑制治疗结束。在接受阿昔洛韦治疗的患者中没有VZV的突破性再激活。5例接受环孢霉素或泼尼松龙治疗的患者在停用阿昔洛韦后出现VZV再激活。通过这种预防，移植后1年VZV再激活的累积发生率从33%降至10%（P = 0.025）。在多变量分析中，长期使用阿昔洛韦被确定为VZV再激活发展的重要独立参数。这些结果表明，长期预防低剂量阿昔洛韦的疗效。在重新开始免疫抑制治疗后重新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得到前瞻性证实。
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 longterm 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 longterm 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.