High Incidence of Varicella Herpes Zoster with Use of Bortezomib in Chinese Patients.

Bortezomib has been used for patients with refractory and relapsed multiple myeloma, non-Hodgkin lymphoma and leukemia in recent years. It has several complications. Here we report the complication of varicella herpes zoster after using bortezomib, which has higher incidence in Chinese patients. Ten patients were treated with bortezomib in our hematology centre. Among them, seven patients had refractory and relapsed multiple myeloma, two patients had refractory lymphoma (one of T cell lymphoma and one of mantle cell lymphoma) and one patient had refractory acute myeloblastic leukemia. All the patients received bortezomib (1.3 mg/m²) on days 1, 4, 8, and 11 of a 3-week cycle. Patients of multiple myeloma received dexamethasone simultaneously. The combination with liposomal doxorubicin was used on the patients of lymphoma. The patient of acute myeloblastic leukemia received bortezomib in combination with Amsacrine. After one cycle, 6 patients with multiple myeloma responded to treatment (four near complete remission, two partly remission). Two patients with lymphoma reached PR. The patient with leukemia had no response. A remarkable observation in our treatment was the high incidence of varicella herpes zoster. Six out of ten patients developed varicella herpes zoster. Among the six patients, two patients had previous infection of the zoster virus before. Most of the patients had the varicella herpes zoster infection after the complete of one cycle of bortezomib and were disappeared within one month by the use of antiviral treatment. The incidence of varicella hepers zoster after bortezomib was around 13% as reported. But the higher incidence of varicella herpes zoster were observed in our patients. Six of ten patients (60%) developed varicella zoster virus infection during treatment. We considered that the Chinese patients may be more liable to varicella zoster virus infection. And further observations should be made in the future. Prophylactic antiviral medication might be used in predisposed patients who receive bortezomib.