Acyclovir prophylaxis for Velcade based therapies – pro

The bortezomib and dexamethasone treatment is myelosupressive. The APEX trial demonstrated an incidence of H. Zoster of 13% in the bortezomib-treated arm compared with 5% in the dexamethasone-treated arm (p<0.001)in patients treated for myeloma. Some subsequent studies showed lower H. Zoster infection rates and others showed similar rates. For this reason, many experts recommend routine acyclovir prophylaxis for high-risk patients treated with bortezomib. National Comprehensive Cancer Network guidelines recommend that herpes zoster prophylaxis be considered for patients receiving bortezomib or bortezomib-based therapies.

Routine acyclovir prophylaxis is not guideline recommended in transplant patients. MMWR says: “Prophylaxis or preemptive therapy with acyclovir is not recommended because of lack of efficacy”. Supressive therapy because of previous shingles is noto prospectively studied in this setting, to my knowedge.

Richardson PG, Sonneveld P, Schuster MW, et al. Bortezomib or high-dose dexamethasone for relapsed multiple myeloma. N Eng J Med. 2005a;352:2487–98.

Dasanu CA, Alexandrescu DTDoes bortezomib induce de facto varicella zoster virus reactivation in patients with multiple myeloma? J Clin Oncol, doi: 10.1200/JCO.2008.21.0138.

Chanan-Khan A, Sonneveld P, Schuster MW, et al.(2008) Analysis of herpes zoster events among bortezomib-treated patients in the phase III APEX study. J Clin Oncol 26:4784–4790.

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