Herpesviridae Viral Infections Following Chemotherapy in Patients with Lymphoma : Incidence, Risk Factors, and Prevention.

Herpesviridae family includes herpes simplex virus, varicella zoster virus, Epstein-Barr virus, and cytomegalovirus, etc. Herpesviridae viral infection(HVI) can lead to serious complications including dissemination, secondary infection, bacterial superinfection in patients with lymphoma undergoing chemotherapy. But there was no consensus on the dose and duration of antiviral agents prophylaxis in lymphoma undergoing chemotherapy. We retrospectively analyzed the incidence, the risk factors and the prevention with low-dose acyclovir for HVI.

A total of 266 patients who newly diagnosed and received an chemotherapy without prophylaxis of acyclovir at the Kosin University Gospel Hospital, Busan, South Korea between June 1996 and August 2009 were enrolled retrospectively in the current study. HVI was confirmed based on clinical diagnosis, serologic test or pathologic diagnosis. The characteristics of the patients were as follows: the median age was 54years (range 15-83 years) with a female-to-male ratio of 150:116. The enrolled diseases included diffuse large B cell lymphoma (DLBL, n=151, 56.8%), Hodgkin's disease (HD, n=16, 6.0%), T cell lymphoma (TCL, n=43, 16.2%) and other lymphoma (n=56, 21.1%) including mantle cell lymphoma, marzinal zone B cell lymphoma, follicular lymphoma, small lymphocytic lymphoma and burkitt's lymphoma. The results were analyzed using a chi-square test and independent samples T test. For the multivariate analysises, we used logistic regression test.

Fourty three patients (16.2%) developed HVI at a median of 5.43 months (range 0.43-51.33 months) after initial chemotherapy. In univariate analyses, risk factors for HVI were gender (p=0.002, 10% in male vs 24.1% in female), cumulative dose of prednisone (p < 0.001, 4.0% in less than 4000mg vs 31.6% in more than 4000mg), duration of chemotherapy (p=0.009, 11.8% in less than 6 months vs 24.0% in more than 6 months), presence of relapse (p=0.007, 24.7% in relapse vs 11.9% in non-relapse), receiving salvage chemotherapy (p=0.009, 11.8% in no receiving salvage chemotherapy vs 24.0% in receiving salvage chemotherapy), and presence of neutropenic fever (p=0.019, 26.9% in neutropenic fever vs 13.6% in no neutropenic fever). In multivariate analysis, the results confirmed 2 variables as independent predictive factors for the female (P < 0.001, hazard ratio (HR): 4.915, 95% confidence interval (CI) 2.200-10981) and cumulative dose of prednisone (P < 0.001, HR: 14.269, 95% CI 5.241-38.848). There was no different mortality rate and survival rate between HVI and non-HVI group.

Female and high dose prednisone was seemed to be high risk for HVI in patients with lymphoma undergoing chemotherapy without acyclovir prophylaxis. Low-dose acyclovir prophylaxis for HVI may be needed in higher risk lymphoma patients undergoing chemotherapy.

No relevant conflicts of interest to declare.