Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

Pour, Luděk; Adam, Zdeněk; Burešová, Lucie; Krejčí, Marta; Křivanová, Andrea; Sandecká, Viera; Zahradová, Lenka; Büchler, Tomáš; Vorlíček, Jiří; Hájek, Roman

doi:10.3816/clm.2009.n.036

Cited by 45 publications

(31 citation statements)

References 10 publications

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“…[139][140][141][142] Prophylaxis with acyclovir, valacyclovir, or famciclovir should be protective and can be considered in these settings. 143,144 Among patients with CLL receiving alemtuzumab treatment, antiviral prophylaxis is recommended until 2 months after completion of treatment or until the CD4+ cell counts reach 200/mcL or greater, whichever occurs later.…”

Section: Antiviral Prophylaxis and Preemptive Antiviral Therapymentioning

confidence: 99%

Prevention and Treatment of Cancer-Related Infections

Baden¹,

Bensinger²,

Angarone³

et al. 2012

J Natl Compr Canc Netw

188

146

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Section: Antiviral Prophylaxis and Preemptive Antiviral Therapymentioning

confidence: 99%

Prevention and Treatment of Cancer-Related Infections

Baden¹,

Bensinger²,

Angarone³

et al. 2012

J Natl Compr Canc Netw

188

146

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“…One study compared acyclovir 400 mg once daily to 3 times daily dosing and both regimens were shown to protect from the risk of VZV reactivation. 4 Our patient did not receive VZV prophylaxis during her bortezomib use at the outside facility; if utilized, it may have prevented the development of disseminated VZV.…”

Section: Sectionmentioning

confidence: 86%

Clinical Reasoning: A 56-year-old woman with acute vertigo and diplopia

et al. 2018

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A 56-year-old woman with a recent diagnosis of primary light-chain (AL) (lambda type) amyloidosis complicated by mild infiltrative cardiomyopathy and autonomic neuropathy had sudden onset vertigo and diplopia. She also had a history of hyperlipidemia and hypothyroidism. The diplopia was binocular and worsened on rightward gaze. The patient denied headache, fever, neck stiffness, photophobia, confusion, tinnitus, or impaired hearing. Prior to presentation, she had completed her third cycle of chemotherapy at an outside facility for AL amyloidosis with bortezomib, lenalidomide, and dexamethasone and had come to our facility for a second opinion regarding her amyloidosis when this event happened. Her other medications included aspirin, atorvastatin, levothyroxine, spironolactone, torasemide, midodrine, calcium, and vitamin D. She did not smoke or use alcohol. Her vital signs included a temperature of 36.4°C, blood pressure 109/82 mm Hg, and heart rate 80. Her general examination revealed cachexia and bilateral pitting edema. Her neurologic examination revealed a right sixth cranial nerve palsy, direction-changing nystagmus, mild right-sided dysdiadochokinesis, and mild weakness (Medical Research Council grade 4 of 5) of the deltoids and iliopsoas bilaterally; head impulse test was negative and there was no skew deviation. Her mental status, gait, reflexes, and sensory examination were within normal limits. A skin examination revealed a scattered pustular right-sided rash in the peri-auricular region, neck, chest, and thigh, which the patient mentioned was of new onset. There was no periorbital purpura or macroglossia.

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“…This has been reported in other studies that incorporated bortezomib in the relapsed setting of multiple myeloma. 24 Our patients were not treated with antiviral prophylaxis, but, given data suggesting efficacy of this approach in patients with multiple myeloma treated with bortezomib, 25,26 we would suggest that antiviral prophylaxis be used for future combination studies, including bendamustine and bortezomib.…”

Section: Discussionmentioning

confidence: 99%