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Summary:center experience, which included 1000 liver transplants, major adverse events potentially related to FK506 included neurotoxicity in 7%, insulin-dependent hyperglycemia in To determine how well tacrolimus (FK506) and cyclosporin A (CsA) are tolerated after HLA-identical blood 13-16%, hypertension in 29-39%, hyperkalemia in 42-47%, and significant infections in 10-36%. 7 Nephrotoxicstem cell transplantation, we performed a retrospective review of 87 adults transplanted consecutively who ity, manifested by magnesium wasting and a reduction in creatinine clearance, is the most serious side-effect of received FK506 (n = 40) or CsA (n = 47) in a nonrandomized fashion in combination with methylpredniso-FK506. Some degree of renal impairment has been reported in up to 48% of solid organ transplant recipients. 8,9 lone for graft-versus-host disease (GVHD) prophylaxis and compared the incidences of complications potenDrug-related toxicities may have a substantial impact on early morbidity and mortality after allogeneic marrow or tially related to the immunosuppressive agents. Pretransplant demographic characteristics, drug comblood stem cell transplantation. Both FK506 and CsA are effective for prevention of acute GVHD, but their toxicities pliance and rates of acute GVHD were comparable for the two groups. Following first discharge, fewer patients after marrow or blood stem cell transplantation have not been compared. To determine whether, based on toxicity in the FK506 group required antihypertensive therapy (32 vs 59%, P = 0.022), but more required insulin (34 profiles, there is any basis for preferential use of FK506 or CsA in these patients, we have reviewed the immunosupvs 10%, P = 0.014). There was also a trend for more hyperkalemia and less moderate-to-severe venopressive-related toxicities to day 100 in a consecutive series of HLA-identical blood stem cells transplant recipients. occlusive disease in the FK506 group. However, nephrotoxicity, neurotoxicity, hemolytic-uremic syndrome, and cytomegaloviral or fungal infections through the first 100 days post-transplant did not differ significantly Patients and methods between the two groups. We conclude that for allogeneic blood stem cell transplant recipients, the incidence of Patients complications related to FK506 and CsA in equallyWe retrospectively reviewed the charts of 87 adults transeffective dose schedules in combination with methylplanted over a consecutive 22-month period with unmanipprednisolone are similar with the exception of the risks ulated filgrastim-mobilized HLA-identical blood stem cells of hypertension and hyperglycemia.following administration of a myeloablative regimen for

BACKGROUND: It is common practice to administer acyclovir as prophylaxis to patients with hematologic malignancies during neutropenia; however, effective therapy requires frequent dosing, which is difficult in this setting. Valacyclovir has greater oral bioavailability and requires less frequent dosing. OBJECTIVE: To evaluate the efficacy and safety of valacyclovir compared with acyclovir. METHODS: Patients who had been treated with chemotherapy or stem-cell transplantation were randomized to receive acyclovir 400 mg orally 3 × daily (n = 51), valacyclovir 500 mg orally twice daily (n = 48), or valacyclovir 250 mg orally twice daily (n = 52) during neutropenia. RESULTS: Clinical success, defined as the absence of an active herpes simplex virus (HSV) lesion or asymptomatic viral shedding, was similar between the 3 groups (acyclovir 96%, valacyclovir 500 mg 95%, valacyclovir 250 mg 100%). The overall rates of adverse events were similar in the 3 groups. CONCLUSIONS: Prophylactic treatment with valacyclovir is an effective and safe alternative to acyclovir for the prevention of HSV reactivation in patients with hematologic malignancies.

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