acyclovir and Leukemia--Lymphoid

Topics: Acute Disease; Acyclovir; Anti-Bacterial Agents; Bacterial Infections; Catheterization; Chickenpox; Gram-Negative Bacteria; Herpes Zoster; Humans; Immunization; Immunization, Passive; Infection Control; Leukemia, Lymphoid; Mycoses; Protozoan Infections; Sulfamethoxazole; Trimethoprim

The occurrence of HSV infection and the effect of prophylaxis with oral acyclovir were evaluated prospectively in 34 consecutive patients undergoing bone marrow transplantation (BMT). All allogeneic BMT procedures involved T-lymphocyte depletion for prevention of graft-vs.-host disease (GVHD). Five HSV-seronegative patients did not receive acyclovir, and they did not develop HSV infection. Oral acyclovir was administered to 15 HSV-seropositive BMT recipients; 14 untreated HSV-seropositive BMT recipients served as a control group. The adult dose of acyclovir was 400 mg three times a day on Days -6 to +14 and 200 mg three times a day on Days +15 to +90. Children received 500 mg/m2 per day divided into three equal doses on Days -6 to +14 and 250 mg/m2 per day again divided into three on Days +15 to +90. In the group on prophylaxis, only one developed HSV infection during the time prior to engraftment. In the reference group, 12 of 14 (85.7%) developed oral HSV infection within 0 to 16 days (median 11 days) after the transplantation. Time for engraftment (duration of neutropenia) was shorter in patients receiving acyclovir. After engraftment, HSV infection was not observed during administration or following discontinuation of acyclovir on Day 90, but occurred in three patients in whom acyclovir was discontinued on Days 25, 35 and 40 after BMT. In the untreated group, two patients had recurrence of HSV infection on Days 40 to 60, and one had two infectious episodes. GVHD occurred in only two recipients, neither of whom had HSV infection. We conclude that the incidence of HSV infection during the period until engraftment in recipients of T-lymphocyte-depleted BMT is high, similar to that reported by others in recipients of whole BMT. Relatively low-dose oral acyclovir administered for 90 days can effectively prevent HSV infections in previously HSV-seropositive BMT recipients and may also shorten the period until engraftment.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Anemia, Aplastic; Bone Marrow Transplantation; Child; Child, Preschool; Clinical Trials as Topic; Drug Administration Schedule; Female; Graft vs Host Disease; Herpes Simplex; Histocompatibility Testing; HLA Antigens; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Lymphocyte Depletion; Male; Middle Aged; Stomatitis, Herpetic; T-Lymphocytes; Transplantation, Homologous

Orofacial mucocutaneous infections resulting from herpes simplex virus (HSV) were detected in 40% of patients with acute leukemia. Of the 34 separate episodes, oral mucosal sites were involved in 22 cases. Evidence to support dissemination of HSV was found in 3 patients on 4 separate occasions. The relationship of neutrophil levels to the onset and resolution of lesions is examined. The value of acyclovir for treatment of these HSV-induced lesions is reported, and the question of administering this agent for routine prophylaxis against HSV in these patients is addressed.

Topics: Acute Disease; Acyclovir; Adult; Clinical Trials as Topic; Herpes Labialis; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Prospective Studies; Stomatitis, Herpetic; Time Factors

Forty-one patients receiving remission induction chemotherapy with vincristine, adriamycin and prednisolone (VAP) for high grade lymphoma or acute lymphoblastic leukaemia were entered into a double blind, placebo controlled trial of oral acyclovir prophylaxis against herpes simplex virus (HSV) infection. The dose of acyclovir was 200 mg four times daily for the duration of chemotherapy (six weeks). Of the 40 evaluable patients, 20 were randomised to each arm. Prophylactic oral acyclovir significantly reduced the incidence of clinical HSV infection from 60% on placebo to 5% acyclovir (P less than 0.001), and the incidence of viral isolates from 70% on placebo to 5% on acyclovir (P less than 0.001).

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Clinical Trials as Topic; Double-Blind Method; Doxorubicin; Drug Resistance, Microbial; Female; Herpes Simplex; Humans; Leukemia, Lymphoid; Lymphoma; Male; Middle Aged; Procarbazine; Random Allocation; Vincristine

Immunocompromised patients are developing in an increasing frequency acyclovir-resistant herpes simplex infections. Different treatment options need to be evaluated considering the possible side effects in regard to the patients' immunocompromised status. A 73-year-old woman with B-cell lymphatic leukemia with a secondary antibody deficiency syndrome and anemia suffered for one year with perianal ulcerations caused by acyclovir-resistant herpes simplex infection Type II. Based on previous reports about successful treatment of acyclovir-resistant herpes simplex infections with foscarnet, cidofovir or vidarabine and considering the different side effects of these drugs as well as the underlying diseases of the patient, we treated her with foscarnet intravenously. After 3 months the ulcers showed a nearly complete remission.

Topics: Acyclovir; Aged; Antiviral Agents; Drug Resistance, Microbial; Female; Foscarnet; Herpes Simplex; Herpesvirus 2, Human; Humans; Immunocompromised Host; Leukemia, Lymphoid; Time Factors

Cytomegalovirus (CMV) infection is relatively frequent and severe in immunosuppressed patients giving rise to diagnostic and therapeutic problems. We describe a series of 7 patients, six with acute lymphoblastic leukemia and one with aplastic anemia. All patients had CMV infection at the moment of maximum immunodepression. Two patients had undergone recent bone-marrow transplant. Six had been transfused in the two months prior to the onset of infection. Diagnosis was established through isolation of CMV from blood or serological methods. Symptoms ranged from prolonged fever to multi-organic involvement. Two cases had pulmonary involvement as well as fever, hepatitis and petechial rash. Two other cases presented with fever and hepatosplenomegaly and in the remaining, 3, fever was the only sign. Clinical course was favourable in all cases including the two with pneumonitis; of these two the first received acyclovir and anti-CMV Ig and the other received no specific therapy. One of the remaining cases was also given acyclovir and specific anti CMV Ig was administered to the 3 patients with isolated fever. In conclusion, CMV infection should be suspected in immunosuppressed patients with prolonged fever.

Topics: Acyclovir; Anemia, Aplastic; Antineoplastic Agents; Bone Marrow Transplantation; Child; Child, Preschool; Combined Modality Therapy; Cytomegalovirus Infections; Female; Fever; Humans; Immunization, Passive; Immunologic Deficiency Syndromes; Infant; Leukemia, Lymphoid; Male; Postoperative Complications

Topics: Acyclovir; Antiviral Agents; Bromodeoxyuridine; Chronic Disease; Foscarnet; Humans; Immunosuppression Therapy; Leukemia, Lymphoid; Male; Middle Aged; Phosphonoacetic Acid; Stomatitis, Herpetic; Vidarabine

Topics: Acyclovir; Antineoplastic Combined Chemotherapy Protocols; Blood Transfusion; Chickenpox; Child; Female; Herpes Zoster; Humans; Immunization, Passive; Immunosuppression Therapy; Leukemia, Lymphoid; Male; Prospective Studies; Random Allocation; Remission Induction

Bone marrow transplantation was performed between IV/82 and X/85 in 64 patients with acute leukemia (n = 36), chronic myelogenous leukemia (CML; n = 13), severe aplastic anemia (n = 12), and neuroblastoma stage IV (n = 3). Of these patients 57 received allogeneic marrow from HLA-ABCDR identical, MLC-negative sibling donors. Six transplants were performed with syngenic marrow and one with autologous marrow. Of the 64 patients 48 survived 40-1,250 days after transplantation, resulting in a survival rate (SR) of 75% and a survival probability (SP) of 71%. Of the 36 patients suffering from acute leukemia (SR = 64%, SP = 51%), patients with acute myelogenous leukemia (AML) in first complete remission (n = 11; SR = 81%, SP = 76%), as well as patients with acute lymphatic leukemia (ALL) in 1st to 4th complete remission at the time of transplantation (n = 14; SR = 81%, SP = 76%) show a favorable prognosis. A poor survival rate was seen for patients with AML when transplanted in second or partial remission (1/5; SR = 20%), as well as for patients suffering from ALL and transplanted during relapse or partial remission (1/6; SR = 16%). Of 13 patients suffering from CML 12 survived the transplantation free of relapse (SR = 93%, SP = 92%), and one patient died from varicella zoster pneumonia. Of the transplanted patients with severe aplastic anemia, 12 of 13 are surviving with complete hematologic reconstitution; one patient, however, died on day 10 from a sepsis. In our patient group, the SR as well as the SP has been improved through changes in the irradiation protocol concomitant with prophylactic application of anti-CMV hypergammaglobulin, as well as through additional oral medication of Azyklovir. The 41 patients (BMT No. 7-47) with total body irradiation at one time show an SR of 44% and an SP of 41%. The following 46 patients (BMT No. 48-93) have reached an SR of 83% and an SP of 74% under the regimen of fractionated total body irradiation, plus prophylaxis with anti-CMV hypergammaglobulin and Azyklovir. Within this group, no fatal CMV pneumonia was encountered as opposed to six patients lost from CMV pneumonia in the first group.

Topics: Acyclovir; Adolescent; Adult; Anemia, Aplastic; Bone Marrow Transplantation; Child; Child, Preschool; Combined Modality Therapy; Cytomegalovirus Infections; Graft vs Host Disease; Humans; Immunization, Passive; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Middle Aged; Neoplasm Staging; Neuroblastoma; Pneumonia, Viral; Postoperative Complications

A patient with chronic lymphocytic leukemia and severe and frequently recurring herpes labialis received oral acyclovir for more than 18 months, during most of this period at a low dosage (400 mg/d). This regimen was fully successful in preventing recurrences, with no adverse effects.

Topics: Acyclovir; Administration, Oral; Aged; Herpes Labialis; Humans; Immune Tolerance; Leukemia, Lymphoid; Long-Term Care; Male; Recurrence

Considerable progress has been made in the supportive care of patients undergoing cancer therapy. This progress has been associated with the improved survival of some patients. However, infection continues to be the major fatal complication in cancer. patients. The response of granulocytopenic patients with infections to some of the current available antibiotics is suboptimal. Since neutropenia is common during cancer treatment, there is a continual risk of infection in cancer patients; thus it is important for medical oncologists to become aware of these complications and their management. The most frequent types of acute infections, their clinical manifestations, and available antibiotic therapies were reviewed.

Topics: Acyclovir; Anti-Bacterial Agents; Bacterial Infections; Fever; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Neoplasms; Neutropenia; Vidarabine; Virus Diseases

The authors report a case of chronic herpes virus infection of the face which developed in a 70-year old man already affected with chronic lymphocytic leukaemia of the B-cell type (CLL-B) with specific cutaneous localisations. Immunodepression was indicated only by marked hypogammaglobulinaemia. Cell-mediated immunity was preserved. The cutaneous lesions of the face were chronic and presented as pyodermatitis vegetans. A one-week course of acyclovir administered by intravenous infusion in doses of 5 mg/kg three times a day resulted in rapid and dramatic cure, but this result proved transient, since the virus infection relapsed 2 1/2 months later. The new episode also was successfully treated with a second course of acyclovir. The herpes virus infection had developed only on those skin areas that were specifically affected by the leukaemia; after treatment and eradication of the virus, massive lymphocytic infiltration of the dermis persisted in these areas. Involvement of the skin is rare in CLL-B and has been reported mainly in CLL-T. The lesions most frequently encountered are tuberous and papular lesions and infiltrated plaques on the forehead and ears. The pyodermatitis vegetans presentation is unusual. The reasons why viral skin lesions develop on those caused by leukaemia are unknown.

Topics: Acyclovir; Aged; B-Lymphocytes; Chronic Disease; Facial Dermatoses; Herpes Simplex; Humans; Immune Tolerance; Leukemia, Lymphoid; Male; Pyoderma; Skin Neoplasms

Topics: Acyclovir; Administration, Oral; Brain; Herpes Simplex; Humans; Leukemia, Lymphoid; Male; Middle Aged

Four immunosuppressed patients are described with chronic ulcerative herpes simplex virus infection in the sacral and perianal area. Three of these patients were evaluated for decubitus ulcers. Prompt diagnosis was possible when the characteristic morphologic features were recognized and when viral culture and Tzanck smear specimens were obtained. Previously reported cases are reviewed as well. Chronic mucocutaneous herpes simplex infections are complications of immunocompromised hosts and should be recognized early if appropriate therapy is to be initiated.

Topics: Acyclovir; Adult; Anus Diseases; Female; Glomerulosclerosis, Focal Segmental; Herpes Simplex; Humans; Immunosuppression Therapy; Leukemia, Lymphoid; Lupus Erythematosus, Systemic; Male; Middle Aged; Sacrococcygeal Region

Opportunistic viral infections were investigated in 156 adult patients admitted over one year to a medical oncology service: 35% of the total group and 65% of those with acute leukaemia experienced viral infections, 79% of which were with viruses of the herpes group. Surprisingly few enteric viruses were recovered. Reactivation of herpes simplex virus in the brains of these immunosuppressed patients was suggested by the demonstration by nucleic acid hybridization of herpes simplex virus DNA sequences in neurones and endothelial cells in patients with evidence of past infection with virus. Acyclovir was effective in therapy and prophylaxis. Twenty-three strains from 7 patients were tested for sensitivity to this antiviral: in 3 instances clinical resistance was observed but the strains were fully sensitive in vitro, as were all other strains tested.

Topics: Acyclovir; Adult; Brain; Breast Neoplasms; Bronchial Neoplasms; DNA, Viral; Herpes Simplex; Humans; Immunosuppression Therapy; Leukemia, Lymphoid; Leukemia, Myeloid; Lymphoma; Nucleic Acid Hybridization; Simplexvirus; Virus Diseases

Ten children between the ages of five and fifteen years old with leukemia (two with acute nonlymphocytic leukemia in first remission, four with acute lymphocytic leukemia in first or second remission, one with acute lymphocytic leukemia in relapse, and one with chronic myelocytic leukemia in chronic phase), malignant lymphoma (one) or severe aplastic anemia (one) were given transplants from HLA-matched or mismatched family members between March, 1982 and April, 1984. Two patients died of leukemia relapses on days 107 and 257 following transplantation. One patient died of cardiac failure on day 157. One patient who received HLA-mismatched marrow from his father died of pulmonary edema and acute graft versus host disease on day 32. Six are alive 268-843 days post transplantation. None of the ten patients developed interstitial pneumonia due to cytomegalovirus which is one of the major causes of death reported in other published studies.

Topics: Acute Disease; Acyclovir; Adolescent; Anemia, Aplastic; Bone Marrow Transplantation; Child; Child, Preschool; Cyclophosphamide; Female; Graft vs Host Disease; Herpesviridae Infections; Humans; Immunologic Deficiency Syndromes; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Lymphoma; Male; Methotrexate; Transplantation, Homologous

Primary varicella-zoster virus infection (chickenpox) in immunocompromised children is frequently associated with visceral dissemination and attendant high mortality. Eight children with malignant neoplasms and chickenpox with visceral involvement (seven with hepatitis, three with pneumonitis, two with encephalitis, and two with coagulopathy) were initially treated with intravenously (IV) administered vidarabine but demonstrated progressive visceral involvement. After three days of vidarabine treatment (two days for two patients), seven had rising serum SGPT levels, all eight had pneumonitis, seven had deteriorating mental status and/or seizure activity, and six had worsening coagulopathy. Vidarabine was replaced by IV administered acyclovir, with subsequent improvement in all but the most severely ill patient who died. Seven of eight patients recovered completely; no side effects of acyclovir were observed. This clinical experience suggests that acyclovir may be more effective than vidarabine in disseminated varicella infection; however, controlled clinical trials will be necessary to establish this.

Topics: Acyclovir; Blood Coagulation Disorders; Chickenpox; Child; Encephalitis; Female; Hepatitis, Viral, Human; Humans; Leukemia, Lymphoid; Lymphatic Diseases; Male; Pneumonia, Viral; Vidarabine

Topics: Acyclovir; Chickenpox; Child; Child, Preschool; Female; Herpes Simplex; Humans; Leukemia, Lymphoid; Male

Allogeneic bone marrow transplantations were carried out between March 1983 and July 1985 in 31 patients aged 7 to 45 years (median 18 years). Acute lymphoblastic leukaemia in 1st to 5th remission was present in 8 patients, acute myeloblastic leukaemia in 1st and 2nd remission in 4 patients, chronic myeloid leukaemia, with various remission status, in 6 patients, 3 patients had severe aplastic anaemia and there were single cases of myelodysplasia and immature cell megakaryocytic myelosis. Transplantation was carried out during relapse in 8 patients with either acute myeloid or lymphoblastic leukaemia. Phenotypic HLA-identical mothers (n = 2) as well as genotypic HLA-identical siblings (n = 27), and in two cases HLA-non-identical mothers, served as bone marrow donors. In leukaemia patients the conditioning treatment consisted of fractionated total body irradiation and high dose cyclophosphamide or etoposide. Patients with severe aplastic anaemia received cyclophosphamide (4 X 50 mg/kg) and fractionated total nodal irradiation (total dose 8 Gy). 19 patients (61%) survived 14 to 605 days after bone marrow transplantation. 15 patients (48%) continue to remain in complete remission with Karnofsky indices of greater than or equal to 90%. Causes for death were infection (n = 3), interstitial pneumonia (n = 3), relapse (n = 3) as well as single cases involving acute graft-versus-host-disease, non-engraftment of donor marrow and veno-occlusive disease of the liver.

Topics: Acyclovir; Adolescent; Adult; Amphotericin B; Anemia, Aplastic; Bone Marrow Transplantation; Child; Cyclophosphamide; Etoposide; Female; Graft Survival; Graft vs Host Disease; Herpes Genitalis; HLA Antigens; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Male; Methotrexate; Middle Aged; Nystatin; Prednisolone; Tissue Donors; Whole-Body Irradiation

An eight-year-old girl with acute lymphoblastic leukaemia (ALL) in remission presented with varicella. Zoster immune globulin was not given, but treatment with acyclovir was commenced the day after presentation and continued for five days. Many of the original vesicles ulcerated and persisted for periods in excess of three months, finally leaving residual scarring. Further new vesicles appeared at 80 days and 109 days, and virus was again visualised by electron microscopy. Seroconversion was not demonstrated, although the child has in the past responded serologically to other viruses. A series of other infections afflicting the child at about the same time is documented and the possible implications are discussed.

Topics: Acyclovir; Chickenpox; Child; Female; Herpesvirus 3, Human; Humans; Leukemia, Lymphoid; Recurrence; Time Factors

Acyclovir is a new antiviral agent which is active in vitro and in vivo against a variety of herpesviruses. Two cases are reported in which intravenous administration of acyclovir arrested the progress of disseminated herpes zoster within 24 to 48 hours after the beginning of therapy. There was no evidence of toxicity. Thus, acyclovir appears to be useful in the therapy of herpes zoster, but this requires evaluation.

Topics: Acyclovir; Aged; Female; Herpes Zoster; Humans; Leukemia, Lymphoid; Lymphoma, Non-Hodgkin; Middle Aged

Topics: Acyclovir; Chickenpox; Child; Guanine; Herpes Zoster; Humans; Immunization, Passive; Immunosuppression Therapy; Leukemia, Lymphoid; Male; Vasculitis

Three patients in whom herpes zoster infections developed following bone marrow transplantation were treated with acyclovir. The patients experienced pain relief within 24 hours of starting treatment. The progression of their skin lesions halted within 1, 2, and 4 days of therapy, respectively, and healed completely within two weeks of therapy. Pharmacokinetic studies indicated that acyclovir plasma concentration-time profiles approximated biexponential equations. The drug half-lives were 3.91, 3.83, and 3.40 hours, respectively. Acyclovir was not myelotoxic and may be helpful in aborting varicella-zoster virus infections in bone marrow transplant recipients.

Topics: Acyclovir; Adolescent; Antiviral Agents; Bone Marrow Transplantation; Child; Female; Guanine; Half-Life; Herpes Zoster; Humans; Kinetics; Leukemia, Lymphoid; Male; Pain; Postoperative Complications

Topics: Acyclovir; Antibodies, Viral; Antineoplastic Agents; Antiviral Agents; Chickenpox; Child; Guanine; Humans; Leukemia, Lymphoid; Male