Effectiveness of oral acyclovir three times a week regimen for viral prophylaxis among patients receiving bone marrow transplant

Abstract

Introduction: Several guidelines have recommended oral acyclovir at 400 to 800 mg twice daily or IV at 250 mg/m² every 12 hours to prevent HSV and VZV postbone marrow transplantation. However, at King Chulalongkorn Memorial Hospital, patients with hematologic malignancy and undergoing bone marrow transplantation have been given 400 mg oral acyclovir regimen three times a day which is commonly used to prevent HSV and VZV. Still, studies have not yet been conducted to demonstrate this regimen’s antiviral efficacy and safety Objective:  The study aimed to investigate the incidence of HSV and VZV and safety among patients undergoing bone marrow transplant and receiving acyclovir three times a week.  Materials and Methods:  A retrospective study was conducted for adult patients aged 18 years and over receiving a bone marrow transplantation at King Chulalongkorn Memorial Hospital, Thai Red Cross Society between 1 January 2017 and 31 December 2020. General patient data information related to bone marrow transplantation, information on exposure to acyclovir, history of viral infection and adverse reactions were collected. Results: Data were collected from 98 patients receiving bone marrow transplant. Two patients (2%) were found with HSV. The average days of presenting HSV after receiving bone marrow transplantation was 235.5 days. No severe adverse reaction related to acyclovir were observed. Conclusions: Using a 400 mg oral acyclovir regimen three times a day, thrice a week benefitted patients receiving bone marrow transplantation. The incidence of HSV did not differ from the standard regimen with no serious adverse events.