Varicella-zoster virus prophylaxis with low-dose acyclovir in patients with multiple myeloma treated with bortezomib

Clin Lymphoma Myeloma. 2009 Apr;9(2):151-3. doi: 10.3816/CLM.2009.n.036.


Background: Varicella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.

Patients and methods: We studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m2 was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.

Results: A total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.

Conclusion: Varicellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acyclovir / therapeutic use*
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use*
  • Antiviral Agents / therapeutic use
  • Boronic Acids / adverse effects
  • Boronic Acids / therapeutic use*
  • Bortezomib
  • Female
  • Herpes Zoster / prevention & control*
  • Herpesvirus 3, Human / physiology*
  • Humans
  • Male
  • Middle Aged
  • Multiple Myeloma / drug therapy*
  • Multiple Myeloma / virology*
  • Prospective Studies
  • Pyrazines / adverse effects
  • Pyrazines / therapeutic use*
  • Virus Activation / drug effects


  • Antineoplastic Agents
  • Antiviral Agents
  • Boronic Acids
  • Pyrazines
  • Bortezomib
  • Acyclovir