Background Patients with a diagnosis of multiple myeloma (MM) have compromised innate and adaptive immunity, both humoral and cellular. The treatment of this pathology can produce immune alterations such as increasing the incidence of the Varicella–Zoster Virus (VZV) reactivation. The most accepted treatment is acyclovir at prophylactic doses.
Purpose Our objective was to evaluate the adequacy of prophylaxis against VZV in patients with MM treated with daratumumab or carfilzomib.
Material and methods Retrospective observational study in a third-level hospital. For the study, a population sample was obtained from the Farmatools Ambulatory Patient module who were in treatment with daratumumab or carfilzomib from January 2016 to April 2018. Clinical data was also obtained from discharge reports of the haematology service and active treatments in Horus.The registered variables were: name, patient identification number, dates of administration of daratumumab and carfilzomib, and doses and frequency of administration of acyclovir. In addition, the clearance of creatinine and renal pathologies were also recorded. Drug label of acyclovir indicates that a dose of 800 mg daily orally is recommended in immunocompromised patients.
Results A total of 12 patients (seven males and five females) were included, of which eight patients were treated with daratumumab, two with carfilzomib and two patients were treated with both at different times. The mean daily dose of acyclovir was 689.58 mg (SD: 185.76 mg) and the median dose was 800 mg (200–800). One patient was treated with 200 mg daily for chronic kidney disease secondary to a chronic glomerulopathy (serum creatinine of 2 mg/dL) and another patient was treated with 400 mg daily because of moderate renal impairment (serum creatinine of 1.73 mg/dL). The rest of the patients (n=6) were treated with 800 mg daily. No patient developed VZV infection during the treatment of MM.
Conclusion The use of prophylaxis with acyclovir against VZV in patients with MM under active treatment supposes a reduction in the rate of VZV reactivation to zero in our hospital. In our study, all patients had been prescribed an adequate acyclovir regimen individualised to the physiological features of each patient.
References and/or acknowledgements Swaika A. et al. Acyclovir prophylaxis against Varicella–Zoster virus reactivation in multiple myeloma patients treated with bortezomib-based therapies. J Support Oncol 2012; 10:155–9.
No conflict of interest.
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