Prophylaxis of Herpes Zoster Infection in Patients with Multiple Myeloma Treated Bortezomib:

Multicenter Retrospective Analysis

Abstract

Herpes zoster (HZ) is a common viral infection in patients who receive bortezomib, therefore, the prophylactic administration of anti-viral drugs (AVDs) for HZ is recommended. However, the optimum dosage of AVDs for prophylaxis of HZ is unknown. The aim of this study was to evaluate the status of AVDs usage for prophylaxis of HZ and the effect of AVDs for prevention of HZ. We retrospectively analyzed the risk factors of HZ in patients with multiple myeloma, who were treated with bortezomib at nine hospitals in Japan between December 2006 and June 2010, and researched methods of prophylaxis. Of the 113 patients identified, 25 patients developed HZ. The median duration of development of HZ from initiation of bortezomib therapy was 29 days. Twenty-seven patients received AVDs orally for prophylaxis of HZ during bortezomib therapy; 17 patients received 200 mg acyclovir per day, 7 received 400 mg acyclovir per day, 2 received 500 mg valacyclovir per day and 1 received another dosage. One of these 27 prophylactic patients developed HZ; this patient received 200mg acyclovir per day. We analyzed the risk factors for HZ by use of multiple analyses, but could not identify significant risk factors with the exception of the prophylactic administration of AVDs (Odds ratio: 10.544, P = 0.025). Patients with multiple myeloma treated with bortezomib should receive prophylactic administration of AVD for HZ, however 1 patient developed HZ in support of low-dose acyclovir. A prospective trial to determine the optimum dosage of AVDs is required.