Varicella Zoster Virus Reactivation Can be Prevented Very Well By Valacyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BACKGROUND:

Bortezomib is associated with a significant risk of Varicella zoster virus (VZV) reactivation in patients with multiple myeloma (MM). There are some reports that acyclovir or valacycclovir reduces the risk of VZV reactivation. We assessed whether VZV reactivation could be prevented by valacyclovir at a dose of 300 mg bid.

PATIENTS AND METHODS:

We retrospectively evaluated 108 patients with MM who received bortezomib and valacyclovir prophylaxis at the Nanfang Hospital from 2015 to 2017. Patients received valacyclovir prophylaxis orally at a dose of 300 mg bid, without cessation until finishing the whole course of bortezomib treatment.

RESULTS:

The median age was 56 years (range=37-84 years). 57 patients were male and 51 were female. The median bortezomib dose was 31.2 mg/m²(range=5.2-83.2 mg/m²). All patients also received corticosteroids. The median duration of valacyclovir prophylaxis was 333 days (range=38-724 days) and the median valacyclovir dose was 199.8 g (range=22.8-434.4 g). VZV reactivation did not develop in any patient during valacyclovir prophylaxis. Adverse events over grade 3 associated with valacyclovir were not observed.

CONCLUSION:

Valacyclovir at a dose of 300 mg bid appears to be effective at preventing VZV reactivation and was well-tolerated by patients with MM treated with bortezomib.