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Post Transplant Complications

Clinical utility of oral valacyclovir compared with oral acyclovir for the prevention of herpes simplex virus mucositis following autologous bone marrow transplantation or stem cell rescue therapy

Summary:

Oral acyclovir has been demonstrated to prevent reactivation of herpes simplex virus (HSV) infections when administered prophylactically to autologous bone marrow transplant (BMT) recipients or patients undergoing stem cell rescue therapy. Oral valacyclovir, which is converted in the body to acyclovir, has greater oral bioavailability than oral acyclovir and compared with oral acyclovir yields similar acyclovir plasma concentrations with less frequent (twice-daily) dosing. This study compared the efficacy of oral valacyclovir with that of oral acyclovir at preventing HSV mucositis in BMT recipients. A total of 60 HSV-1-positive patients scheduled for BMT or stem cell rescue therapy were treated prophylactically with valacyclovir 500 mg twice daily until resolution of neutropenia. Data from these patients were compared with those of a historical control group of 60 patients who had received acyclovir 600 mg every 6 h until resolution of neutropenia or acyclovir 125 mg/m2 intravenously every 6 h. The results show that none of the patients developed oral or oropharyngeal HSV infection while receiving either treatment. Of the 60 patients receiving valacyclovir, 38 (63%) completed treatment without the need for intravenous acyclovir compared with 12 of 60 (20%) patients in the acyclovir group. Additionally, the total number of doses of drug administered to the valacyclovir group was significantly less than the number received by patients in the acyclovir group. No serious adverse events occurred in either group of patients. This study demonstrates that oral valacyclovir and acyclovir are comparably effective and safe in preventing reactivation of HSV infections in autologous BMT and stem cell recipients. The less frequent dosing schedule with valacyclovir compared with acyclovir offers a potential advantage for patients undergoing BMT who frequently suffer with severe mucositis and have difficulty taking oral medications.

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References

  1. Gluckman E, Lotsberg J, Devergie A et al. Oral acyclovir prophylactic treatment of herpes simplex infection after bone marrow transplantation. J Antimicrob Chemother 1983; 12 (Suppl. B): 161–167.

    Article  Google Scholar 

  2. Schubert MM, Peterson DE, Flournoy N et al. Oral and pharyngeal herpes simplex virus infection after allogeneic bone marrow transplantation: analysis of factors associated with infection. Oral Surg Oral Med Oral Pathol 1990; 70: 286–293.

    CAS  Article  Google Scholar 

  3. Redding SW . Role of herpes simplex virus reactivation in chemotherapy-induced oral mucositis. NCI Monogr 1990; 9: 103–105.

    Google Scholar 

  4. Heimdahl A, Mattsson T, Dahllof G et al. The oral cavity as a port of entry for early infections in patients treated with bone marrow transplantation. Oral Surg Oral Med Oral Pathol 1989; 68: 711–716.

    CAS  Article  Google Scholar 

  5. Lundgren G, Wilczek H, Lonnqvist B et al. Acyclovir prophylaxis in bone marrow transplant recipients. Scand J Infect Dis Suppl 1985; 47: 137–144.

    CAS  PubMed  Google Scholar 

  6. Hann IM, Prentice HG, Blacklock HA et al. Acyclovir prophylaxis against herpes virus infections in severely immunocompromised patients: randomised double blind trial. Br Med J (Clin Res Ed) 1983; 287: 384–388.

    CAS  Article  Google Scholar 

  7. Shepp DH, Newton BA, Dandliker PS et al. Oral acyclovir therapy for mucocutaneous herpes simplex virus infections in immunocompromised marrow transplant recipients. Ann Intern Med 1985; 102: 783–785.

    CAS  Article  Google Scholar 

  8. Selby PJ, Powles RL, Easton D et al. The prophylactic role of intravenous and long-term oral acyclovir after allogeneic bone marrow transplantation. Br J Cancer 1989; 59: 434–438.

    CAS  Article  Google Scholar 

  9. Wade JC, Newton B, Flournoy N et al. Oral acyclovir for prevention of herpes simplex virus reactivation after marrow transplantation. Ann Intern Med 1984; 100: 823–828.

    CAS  Article  Google Scholar 

  10. Darby G . Acyclovir – and beyond. J Int Med Res 1994; 22 (Suppl. 1): 33A–42A.

    PubMed  Google Scholar 

  11. Rayani SA, Nimmo CJ, Frighetto L et al. Implementation and evaluation of a standardized herpes simplex virus prophylaxis protocol on a leukemia/bone marrow transplant unit. Ann Pharmacother 1994; 28: 852–856.

    CAS  Article  Google Scholar 

  12. Beutner KR . Valacyclovir: a review of its antiviral activity, pharmacokinetic properties, and clinical efficacy. Antiviral Res 1995; 28: 281–290.

    CAS  Article  Google Scholar 

  13. Acosta EP, Fletcher CV . Valacyclovir. Ann Pharmacother 1997; 31: 185–191.

    CAS  Article  Google Scholar 

  14. Fife KH, Barbarash RA, Rudolph T et al. Valacyclovir versus acyclovir in the treatment of first-episode genital herpes infection. Results of an international, multicenter, double-blind, randomized clinical trial. The Valacyclovir International Herpes Simplex Virus Study Group. Sex Transm Dis 1997; 24: 481–486.

    CAS  Article  Google Scholar 

  15. Eisen D, Essell J, Broun ER . Oral cavity complications of bone marrow transplantation. Semin Cutan Med Surg 1997; 16: 265–272.

    CAS  Article  Google Scholar 

  16. Woo SB, Sonis ST, Sonis AL . The role of herpes simplex virus in the development of oral mucositis in bone marrow transplant recipients. Cancer 1990; 66: 2375–2379.

    CAS  Article  Google Scholar 

  17. Saral R, Burns WH, Laskin OL et al. Acyclovir prophylaxis of herpes-simplex-virus infections. N Engl J Med 1981; 305: 63–67.

    CAS  Article  Google Scholar 

  18. Shepp DH, Dandliker PS, Flournoy N et al. Once-daily intravenous acyclovir for prophylaxis of herpes simplex virus reactivation after marrow transplantation. J Antimicrob Chemother 1985; 16: 385–389.

    Article  Google Scholar 

  19. Lowance D, Hans-H N, Legendre C et al. Valacyclovir for the prevention of cytomegalovirus disease after renal transplantation. N Engl J Med 1999; 340: 1462–1470.

    CAS  Article  Google Scholar 

  20. Morris DJ . Adverse effects and drug interactions of clinical importance with antiviral drugs. Drug Saf 1994; 10: 281–291.

    CAS  Article  Google Scholar 

  21. Gold J . The Albion Street Centre database, Sydney, Australia. J Acquir Immune Defic Syndrome Hum Retrovirol 1998; 17 (Suppl. 1): S34–S37.

    Article  Google Scholar 

  22. Sutor GC, Schmidt RE, Albrecht H . Thrombotic microangiopathies and HIV infection: report of two typical cases, features, of HUS and TTP, and review of the literature. Infection 1999; 27: 12–15.

    CAS  Article  Google Scholar 

  23. Schimpff SC, Scott DA, Wade JC . Infections in cancer patients: some controversial issues. Support Care Cancer 1994; 2: 94–104 (see comments).

    CAS  Article  Google Scholar 

  24. Sinnige LG, van der Meer JW et al. Is acyclovir prophylaxis necessary after bone marrow transplantation? Infection 1986; 14: 122–124.

    CAS  Article  Google Scholar 

  25. Winston DJ, Ho WG, Gale RP et al. Prophylaxis of infection in bone marrow transplants. Eur J Cancer Clin Oncol 1988; 24 (Suppl. 1): S15–S23.

    PubMed  Google Scholar 

  26. Englund JA, Zimmerman ME, Swierkosz EM et al. Herpes simplex virus resistant to acyclovir. A study in a tertiary care center. Ann Intern Med 1990; 112: 416–422.

    CAS  Article  Google Scholar 

  27. Darville JM, Ley BE, Roome AP et al. Acyclovir-resistant herpes simplex virus infections in a bone marrow transplant population. Bone Marrow Transplant 1998; 22: 587–589.

    CAS  Article  Google Scholar 

Download references

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The research described in this manuscript was funded in part by Glaxo Wellcome.

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Eisen, D., Essell, J., Broun, E. et al. Clinical utility of oral valacyclovir compared with oral acyclovir for the prevention of herpes simplex virus mucositis following autologous bone marrow transplantation or stem cell rescue therapy. Bone Marrow Transplant 31, 51–55 (2003). https://doi.org/10.1038/sj.bmt.1703817

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Keywords

  • acyclovir
  • valacyclovir
  • herpes simplex virus
  • herpes
  • mucositis

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