acyclovir and Lymphoma

Topics: Acyclovir; Chickenpox; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Drug Evaluation; Drug Interactions; Female; Humans; Immunosuppressive Agents; Infant; Lymphoma; Male; Neoplasms

In a prospective, randomized trial, we compared intravenous acyclovir and vidarabine in the treatment of varicella-zoster virus infection in severely immunocompromised patients who presented within 72 hours of onset of the infection. Eleven patients were treated in each group. Cutaneous dissemination of infection occurred in none of the 10 acyclovir recipients and in 5 of the 10 vidarabine recipients who had presented with localized dermatomal disease (P = 0.016). As compared with vidarabine, acyclovir treatment shortened the median periods during which cultures were positive for the virus (four vs. seven days, P = 0.004) and new lesions formed (three vs. six days, P = 0.03). Acyclovir also shortened the median interval until the first decrease in pain (4 vs. 7 days, P = 0.005), the pustulation of all lesions (4 vs. 7 days, P = 0.0004), the crusting of all lesions (7 vs. 17 days, P = 0.0003), and the complete healing of lesions (17 vs. 28 days, P = 0.003). In addition, acyclovir reduced the incidence of fever (two vs. eight patients, P = 0.015). We conclude that acyclovir is better than vidarabine for the treatment of varicella-zoster infection in immunocompromised patients.

Topics: Acyclovir; Adolescent; Adult; Child; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immune Tolerance; Leukemia; Lymphoma; Male; Prospective Studies; Random Allocation; Vidarabine

Topics: Acyclovir; Adolescent; Child; Child, Preschool; Clinical Trials as Topic; Herpesviridae Infections; Humans; Infant; Leukemia; Lymphoma

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

We conducted a placebo-controlled, double-blind study of acyclovir therapy for acute herpes zoster in immunocompromised patients. Of the 94 patients enrolled in the study, 52 had localized skin lesions at entry, and 42 had disseminated cutaneous zoster. A one-week course of intravenous acyclovir (1500 mg per square meter of body-surface area per day) halted progression of zoster in both groups, as determined by development or progression of cutaneous dissemination, development of visceral zoster, or proportion of cases deemed treatment failures. Significantly fewer patients treated with acyclovir within the first three days after the onset of exanthem had complications of zoster, as compared with patients treated with placebo (P = 0.02 by Fisher's exact test), but acyclovir also stopped progression of zoster in patients treated after three days of rash (P = 0.05 by Fisher's exact test). Acyclovir recipients with disseminated cutaneous zoster had a significantly accelerated rate of clearance of virus from vesicles, as compared with placebo recipients (P = 0.05 by the Breslow test).

Topics: Acyclovir; Adolescent; Adult; Aged; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Immunologic Deficiency Syndromes; Leukemia; Lymphoma; Male; Middle Aged; Neoplasms; Transplantation, Homologous

Herpes zoster (HZ) is a frequent complication after autologous stem cell transplantation (ASCT). The option of zoster prophylaxis with an antiviral drug is described in the literature, but there is no consensus on the drug and the dosage.. We analyzed the records of 310 patients treated with ASCT who were controlled regularly regarding HZ inter alia for at least 24 months following ASCT. Since 01/2015 patients received prophylactic low-dose acyclovir (400 mg per day) during the first 12 months following discharge after ASCT (n = 107).. Twenty percent of patients without this kind of prophylaxis and 2.8% of patients with prophylaxis developed HZ (p < .001). No patient with this prophylaxis developed HZ in the first year after ASCT, 2.8% of patients in the second year after ASCT. A prognostic factor was the kind of diagnosis: 30% of lymphoma patients and 14% of myeloma patients developed HZ in the first 24 months after ASCT without prophylaxis, but only 6.3% and 0% of patients with prophylaxis, respectively. Neither an increase of HZ cases following prophylaxis nor acyclovir refractory HZ cases were observed.. Zoster prophylaxis with low-dose acyclovir over 12 months after ASCT is effective and well tolerated.

Topics: Acyclovir; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Lymphoma; Multiple Myeloma; Retrospective Studies; Stem Cell Transplantation; Transplantation, Autologous

The herpesviridae family includes, among others, herpes simplex virus, varicella zoster virus, Epstein-Barr virus, and cytomegalovirus. Herpesviridae viral infections (HVIs) can lead to serious complications in lymphoma patients undergoing chemotherapy. There is no consensus on the dose and duration of antiviral prophylaxis in these patients. We retrospectively analyzed the incidence and risk factors for HVI in lymphoma patients undergoing chemotherapy.. We reviewed the records of 266 patients who were newly diagnosed with lymphoma and received chemotherapy without acyclovir prophylaxis between June 1996 and August 2009.. The cumulative incidence rate of HVI was 20.16% for 5 years from the start of chemotherapy. Independent predictive factors for HVI in lymphoma patients were: female sex [hazard ratio (HR) 2.394; 95% confidence interval (CI): 1.245-4.607; P=0.009], cumulative dose of steroids per body surface area of at least 2500 mg/m(2) (HR 7.717; 95% CI: 3.814-18.703; P<0.001), and history of neutropenic fever (HR 0.297; 95% CI: 0.150-0.588; P<0.001).. Female sex, high dose of steroids per body surface area, and neutropenic fever were risk factors for HVI in patients with lymphoma undergoing chemotherapy without acyclovir prophylaxis.

Topics: Acyclovir; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Female; Fever; Herpesviridae Infections; Humans; Incidence; Lymphoma; Male; Medical Records; Middle Aged; Neutropenia; Odds Ratio; Primary Prevention; Retrospective Studies; Risk Factors; Sex Factors

Lymphoma after heart transplantation (HT) has been associated with induction therapy and herpesvirus infection. It is not known whether anti-viral agents administered immediately after HT can reduce the incidence of lymphoma.. This study was a retrospective review of 3,393 patients who underwent HT in Spain between 1984 and December 2003. Variables examined included development of lymphoma and, as possible risk factors, recipient gender and age, induction therapies (anti-thymocyte globulin, OKT3 and anti-interleukin-2 receptor antibodies) and anti-viral prophylaxis (acyclovir or ganciclovir). To study the effect of evolving treatment strategy, three HT eras were considered: 1984 to 1995; 1996 to 2000; and 2001 to 2003.. Induction therapy was employed in >60% of HTs, and anti-viral prophylaxis in >50%. There were 62 cases of lymphoma (3.1 per 1,000 person-years, 95% confidence interval: 2.4 to 4.0). Univariate analyses showed no influence of gender, age at transplant, HT era, pre-HT smoking or the immunosuppressive maintenance drugs used in the first 3 months post-HT. The induction agent anti-thymocyte globulin (ATG) was associated with increased risk of lymphoma, and prophylaxis with acyclovir with decreased risk of lymphoma. Multivariate analyses (controlling for age group, gender, pre-HT smoking and immunosuppression in the first 3 months with mycophenolate mofetil and/or tacrolimus) showed that induction increased the risk of lymphoma if anti-viral prophylaxis was not used (regardless of induction agent and anti-viral agent), but did not increase the risk if anti-viral prophylaxis was used.. Induction therapies with ATG or OKT3 do or do not increase the risk of lymphoma depending on whether anti-viral prophylaxis with acyclovir or ganciclovir is or is not employed, respectively.

Topics: Acyclovir; Adult; Antilymphocyte Serum; Antiviral Agents; Female; Ganciclovir; Heart Transplantation; Humans; Immunosuppressive Agents; Lymphoma; Male; Middle Aged; Multivariate Analysis; Muromonab-CD3; Registries; Retrospective Studies; Risk Factors; Spain; Virus Diseases

We evaluated the cytotoxic and apoptotic effects of two purine nucleoside analogues, acyclovir (ACV) and ganciclovir (GCV), on lymphoma cells stably harboring Kaposi's sarcoma-associated herpesvirus (KSHV). Colorimetric caspase assay, flow cytometry, and immunoblotting with antibodies against apoptosis-related molecules revealed that GCV has cytotoxic activity toward KSHV-infected primary effusion lymphoma cells, while ACV has weak or little activity. In addition to the GCV-induced cytotoxicity, apoptosis via caspase-7/8, cleavage of poly(ADP-ribose) polymerase, and accumulation of p53 and p21 were induced by GCV treatment. In contrast, neither ACV nor GCV have cytotoxicity- or apoptosis-inducing activities toward uninfected cells.

Topics: Acyclovir; Apoptosis; Caspase 3; Caspase 7; Ganciclovir; Herpesvirus 8, Human; Humans; Lymphoma; Tumor Cells, Cultured

This study was conducted to compare the survival rates of bone marrow transplantation (BMT) patients who were affected with the survival rates of those who were not affected by oral recrudescent human herpes virus-1 infection (HHV-1) after transplantation.. Fifty-two consecutive patients who underwent BMT were included in the study. The time of death after BMT was displayed, by means of the Kaplan-Meier method, for the following parameters: age and gender of the patient, donor gender, primary disease, stem cells, conditioning regimen, platelet number after day 100, acute and chronic graft-versus-host disease, oral recurrent HHV-1 infection post-BMT, oral lichenoid lesions of graft-versus-host disease, graft-versus-host disease at the salivary glands, parenteral nutrition, and oral mucositis. The data were initially analyzed by means of the log-rank test and then included in the Cox proportional hazards model.. The multivariate analysis demonstrated a significance of 5% for only the platelet numbers and oral recurrent HHV-1 infection.. The present study provides evidence that platelet numbers below 100,000 cells/mm(3) after day 100 and oral recurrent HHV-1 infection are independent negative prognostic variables in BMT patients' 24-month survival rates.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Age Factors; Anemia, Aplastic; Antiviral Agents; Bone Marrow Transplantation; Chronic Disease; Female; Graft vs Host Disease; Humans; Leukemia; Linear Models; Lymphoma; Male; Middle Aged; Multivariate Analysis; Platelet Count; Prognosis; Proportional Hazards Models; Recurrence; Salivary Gland Diseases; Sex Factors; Stomatitis; Stomatitis, Herpetic; Survival Rate; Tissue Donors; Transplantation Conditioning

Managing the infectious complications associated with pentostatin (Nipent), used alone or in combination with other agents in patients with low-grade lymphomas, poses a significant problem for clinicians. Since there is limited experience with these therapies, definitive treatment recommendations concerning prophylaxis cannot be made. The panel members discussed the use of valacyclovir (Valtrex) to provide prophylaxis for herpes zoster, trimethoprim/sulfamethoxazole for Pneumocystis, and acyclovir (Zovirax) for varicella zoster. They also considered combinations of pentostatin with agents such as interferon, rituximab (Rituxan), and chlorambucil (Leukeran) and their effect on the immune system. The biology of B and T cells was discussed, with an emphasis on clinical application.

Topics: Acyclovir; Anti-Infective Agents; Anti-Infective Agents, Urinary; Antibiotics, Antineoplastic; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents; Antineoplastic Agents, Alkylating; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Chlorambucil; Encephalitis, Varicella Zoster; Herpes Zoster; Humans; Interferons; Lymphoma; Pentostatin; Pneumocystis Infections; Rituximab; Sulfamethoxazole; Trimethoprim; Valacyclovir; Valine

Pre-emptive treatment strategies based on sensitive screening for cytomegalovirus (CMV) infection up to day +100 after allogeneic transplantation have been shown to reduce the incidence of CMV disease during the period of surveillance. However, the use of ganciclovir has been associated with delays in immune reconstitution and an increased incidence of late CMV disease after day +100. In the present study, 81 patients undergoing allogeneic transplantation received polymerase chain reaction (PCR)-guided pre-emptive therapy based on detection of CMV DNA by PCR on 2 consecutive weeks up to day +180. Thirty-three of the 52 high-risk patients (CMV-seropositive donor or recipient) received a total of 45 treatment episodes up to day +100. Three of these patients (5.7%) developed CMV disease, with one fatality. Twelve of the surviving 44 high-risk patients (27%) required pre-emptive treatment between days +101 and +192, but none of these patients developed late CMV disease with a median follow-up of 402 d (range 117-952 d). Antiviral therapy was stopped after a single negative PCR result with no subsequent episodes of CMV disease while patients remained off antiviral treatment. As all initial episodes of CMV DNA detection occurred within 60 d of transplantation, it may be possible to discontinue monitoring beyond day +100 in patients who have remained CMV PCR negative before this. Thus, we have confirmed that PCR-guided pre-emptive therapy results in a low incidence of CMV disease before day +100 and that discontinuing treatment on the basis of viral clearance as determined by CMV PCR appears to be safe practice. In addition, we have observed no episodes of late CMV disease with an extension of surveillance to 26 weeks.

Topics: Acyclovir; Adolescent; Adult; Antifungal Agents; Antiviral Agents; Bone Marrow Transplantation; Cyclosporine; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Female; Fluconazole; Foscarnet; Humans; Leukemia; Lymphoma; Male; Methotrexate; Middle Aged; Polymerase Chain Reaction; Postoperative Period; Prospective Studies; Risk; Survival Rate; Time Factors; Tissue Donors; Transplantation, Homologous

We present a case of subacute focal encephalitis in a 62-year-old man whose clinical manifestations, neuroradiological findings and histopathological features mimicked those of a patient with malignant lymphoma of the central nervous system (CNS). In addition to routine histopathological examination, extensive studies including serological examination for encephalitic viruses, immunohistochemistry and DNA analysis were required to distinguish focal encephalitis from lymphoma of the CNS, clinical entities which differ in treatment.

Topics: Acyclovir; Antiviral Agents; Blotting, Southern; Brain Neoplasms; Diagnosis, Differential; Encephalitis, Viral; Herpes Simplex; Humans; Lymphoma; Magnetic Resonance Imaging; Male; Middle Aged

Cell lines were derived from mice with murine gammaherpesvirus-68 (MHV-68)-associated lymphoproliferative disease. Four were of an ambiguous phenotype and were MHV-68 negative. One, S11, was a B lymphocyte that contained MHV-68 genomes in both linear and episomal forms and released virus. The line was clonable and grew into tumors in nude mice. This is the first naturally occurring MHV-68-positive B-cell line to be generated, and it will be an invaluable tool for the study of MHV-68 latency.

Topics: Acyclovir; Animals; Antiviral Agents; Culture Techniques; Gammaherpesvirinae; Herpesviridae Infections; Lymphoma; Mice; Mice, Nude; Neoplasm Transplantation; Phenotype; Tumor Cells, Cultured; Tumor Virus Infections

Topics: Acyclovir; Antitubercular Agents; Cyclosporine; Female; Fever; Herpesvirus 4, Human; Humans; Immunosuppression Therapy; Kidney Transplantation; Lupus Erythematosus, Systemic; Lupus Nephritis; Lymphoma; Middle Aged; Prednisone

The aim of this study is to evaluate the benefit of educating lymphoma patients in early self-diagnosis of zoster and subsequent self-referral for prompt treatment. Each of 337 patients attending an out-patient lymphoma clinic was given an explanatory leaflet and photograph about shingles when they first presented with lymphoma. One to two years following the completion of therapy for lymphoma an assessment was made on these patients using a combination of questionnaire survey and retrospective analysis of case notes. Fifty-six (16.6%) of the study population developed zoster following the diagnosis of lymphoma; 29 had had zoster prior to the diagnosis (8.6%). There was an increased incidence of herpes zoster in patients with Hodgkin's disease as compared to those with non-Hodgkin's lymphoma (P < 0.01). Patients who remembered having received the shingles education leaflets were more likely to make self-referral to hospital for prompt treatment (P < 0.001). Long-term complications, eg post-herpetic neuralgia, were less prevalent in patients presenting to hospital for prompt on-demand therapy, compared to those treated in the community. Education of lymphoma patients regarding awareness of early features of zoster is beneficial in preventing complications, but the shingles information episode needs subsequent reinforcement for maximum benefit.

Topics: Acyclovir; Adolescent; Adult; Aged; Herpes Zoster; Humans; Lymphoma; Middle Aged; Patient Education as Topic; Referral and Consultation

In patients with leukemia or lymphoma, the role of preventive oral hygiene in reducing infectious periodontal complications during aggressive chemotherapy is well documented. However, the effectiveness of these measures in preventing further dental or periodontal degradation remains to be demonstrated. 34 hospitalized patients with malignant heamatological diseases were observed. During chemotherapy, tooth brushing was replaced by 3 daily mouth-rinses with 0.2% chlorhexidine digluconate. The periodontal status of these patients, appears unchanged after 12 months. This suggests that the prophylactic measures do prevent a measurable periodontal degradation, even in the presence of pre-existing periodontal disease.

Topics: Acyclovir; Amphotericin B; Ceftazidime; Chlorhexidine; Dental Plaque Index; Fluconazole; Humans; Immunosuppression Therapy; Ketoconazole; Leukemia; Lymphoma; Miconazole; Norfloxacin; Periodontal Diseases; Periodontal Index; Tooth Loss; Vancomycin

We have examined the susceptibility to acyclovir (ACV) of herpes simplex virus isolated from immunocompetent and immunocompromised patients. Susceptibility to ACV was determined in a dye-uptake assay with vero cells grown in 96-well microtitre plates. Resistant strains were found in two out of 35 (5.7%) patients and partially resistant strains in four out of 35 (11.4%) patients immunodeficient as a result of treatment for lymphoid or myeloid malignancy. Strains resistant to ACV were not found in organ transplant recipients or in immunocompetent patients.

Topics: Acyclovir; Adult; Aged; Drug Resistance, Microbial; Female; Herpes Genitalis; Herpes Simplex; Humans; Immune Tolerance; Keratitis, Dendritic; Leukemia; Lymphoma; Male; Middle Aged; Simplexvirus; Transplantation Immunology

Epstein-Barr virus (EBV) is associated with lymphomas and lymphoproliferative diseases that occur mainly in immunocompromised patients, but the role EBV plays in their pathogenesis is unclear. The evidence linking EBV etiologically to these disorders includes the presence of EBV DNA and nuclear antigens in the lesions and serologic evidence that some patients with these lesions are experiencing primary or reactivated EBV infections. These syndromes may represent proliferation of cells latently infected with EBV, but the possibility of viral replication has not been rigorously studied. DNA extracted from biopsies of 35 lymphoproliferative diseases was probed with regions of the EBV genome capable of distinguishing circular, episomal DNA found in latency from linear, replicating EBV DNA. All samples contained restriction fragments characteristic of fused termini, indicative of circular, latent genomes. Thirteen samples contained additional restriction fragments diagnostic of linear EBV DNA. Therefore, replicating EBV DNA is found in approximately 40% of EBV-associated lymphoproliferative disorders.

Topics: Acyclovir; Adolescent; Adult; Blotting, Southern; Burkitt Lymphoma; Cell Line; Child; Child, Preschool; Deoxyribonuclease BamHI; DNA Probes; DNA Replication; DNA, Viral; Female; Herpesvirus 4, Human; Humans; Immune Tolerance; Lymphoma; Lymphoproliferative Disorders; Male; Middle Aged; Nucleic Acid Hybridization; Restriction Mapping; Tumor Cells, Cultured; Virus Replication

We report 12 cases of lymphomas which occurred among 1670 patients with kidney or combined renal and pancreatic transplantation. Group 1 comprised nine patients presenting with the diffuse form of the disease where immunoblasts or mature plasma cells massively infiltrated all organs. The first symptom was a viral syndrome, associated with a restriction of heterogeneity of immunoglobulins; oligoclonal to monoclonal peaks of immunoglobulins appeared about 50 days after transplantation. All patients received antilymphocyte globulins (ALG), and seven were treated with cyclosporin. EBV infection could be demonstrated in almost all patients; three EBV lymphoblastoid cell lines were established, their HLA phenotype being the same as the recipient of the graft. All patients finally died with renal and hepatic failure. Group 2 comprises three patients who presented solid B cell tumours of tonsils, lungs, and spleen at onset, extending to liver, kidney graft, lymph nodes, and brain. All received cyclosporin; two patients were treated with ALG, and one with OKT3. Immunoglobulins were polyclonal, oligoclonal, or decreased. Cell surface immunoglobulins were monoclonal on two tumours. EBV-DNA was positive within two tumours. Two patients presented EBV and CMV primary infection. CD4+T lymphocytes subsets were diminished at onset, and increased after cessation of immunosuppressive therapy. One patient died because of brain involvement; the two others are alive, one with perfect graft function. Therapy consisted of stopping immunosuppressive treatment, Acyclovir, and in two patients of group 2, monoclonal antibodies to pan-B and EBV receptor antigens.

Topics: Acyclovir; Adult; Antilymphocyte Serum; B-Lymphocytes; Cyclosporins; Cytomegalovirus Infections; Female; Fluorescent Antibody Technique; Herpesvirus 4, Human; Humans; Immunoenzyme Techniques; Kidney Transplantation; Lymphoma; Male; Middle Aged; Pancreas Transplantation; Serologic Tests; Tumor Virus Infections

Topics: Acyclovir; B-Lymphocytes; Drug Therapy, Combination; Female; Fluorescein Angiography; Herpes Zoster; Humans; Leukemia, T-Cell; Lymphoma; Middle Aged; Necrosis; Recurrence; Retinitis; Vidarabine

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Anti-Bacterial Agents; Antitrichomonal Agents; Female; Genital Neoplasms, Female; Gonorrhea; Humans; Lice Infestations; Lymphogranuloma Venereum; Lymphoma; Pregnancy; Pregnancy Complications, Infectious; Sarcoma, Kaposi; Sexually Transmitted Diseases; Syphilis

Prevention of EBV-associated lymphoproliferative diseases in immune deficient individuals is preferred; however, standard therapy for the B cell lymphomas has been successful. Chemotherapy must be given cautiously lest further immune compromise result in opportunistic infections. Recently, Acyclovir has decreased morbidity of patients with acute infectious mononucleosis in immune competent persons. In contrast, immunodeficient patients with X-linked lymphoproliferative (XLP) syndrome do not seem to respond favorably. Hence, a prospective study is underway using prophylactic immunoglobulin containing (EBV)-specific antibodies. The mortality rate is 85% following EBV infection in XLP due to fatal infectious mononucleosis associated with fulminant hepatitis and virus-associated hemophagocytic syndrome, acquired hypogammaglobulinemia or malignant B cell lymphoma. We can detect XLP by noting failure of switching from IgM to IgG antibody production on secondary challenge with bacteriophage phi X174. Also, linkage studies with the XLP locus using restriction fragment length polymorphisms are being done to detect affected males pre-EBV infection. Our rationale for prevention of phenotypes of XLP is based on observations that infants in tropical Africa and males with XLP do not develop EBV-induced diseases while neutralizing maternal antibodies are present. An EBV vaccine will be used, when available, in seronegative males with XLP. Prevention of acquired immune deficiency by screening blood for human immune deficiency virus, encouraging prudent life styles, development of specific immunosuppressive agents, development of new antiviral agents (i.e., DHPG), and identification of high risk seronegative patients offer possibilities for preventing life-threatening EBV-induced diseases.

Topics: Acyclovir; Genetic Counseling; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immunologic Deficiency Syndromes; Immunosuppressive Agents; Immunotherapy; Interferons; Lymphoma; Lymphoproliferative Disorders; Male; Prospective Studies; Viral Vaccines; X Chromosome

46 patients suffering from various malignancies (17 non Hodgkin lymphomas, 12 Hodgkin's diseases, 11 acute leukaemias, 4 myelomas, 2 carcinomas), 6 patients with haematological disorders such as ITP, SAA, myeloproliferative disease, LAS and 3 patients without preexisting disease were treated with acyclovir for herpes virus infection diagnosed by clinical means. All but 7 patients had been given intensive treatment with various cytostatic agents and/or irradiation. Most patients were treated with 1500 mg acyclovir daily for 5 to 13 days. Dosage was adjusted according to renal function and clinical response in the remaining 10 cases. 11 patients received intravenous immunoglobulins in addition. Side effects were negligible (local irritation, minimal rise in serum creatinine levels in 5 patients). All patients responded to treatment; 6 patients complained of severe neuralgia lasting for more than one month; 5 patients relapsed.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Chickenpox; Combined Modality Therapy; Female; Herpes Genitalis; Herpes Simplex; Herpes Zoster; Herpesviridae Infections; Hodgkin Disease; Humans; Keratitis, Dendritic; Leukemia; Lymphoma; Male; Middle Aged; Tumor Virus Infections

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

The clinical, immunopathologic, and virologic features of the lymphoproliferative diseases occurring after renal transplantation have been characterized. Clinically, patients may present with an infectious mononucleosis-like illness or with localized solid tumor masses. These lymphoproliferative diseases have unique histologic features that can be classified as polymorphic diffuse B-cell hyperplasia (PDBH) or polymorphic B-cell lymphoma (PBL). Immunologic cell-typing studies have shown that the majority are polyclonal B-cell proliferations, but monoclonal B-cell tumors have also been documented. These B-cell proliferations may, however, evolve from a benign polyclonal B-cell hyperplasia to a monoclonal malignant lymphoma. The Epstein-Barr virus (EBV) has been implicated as the cause of these disorders. Serologic studies frequently demonstrate evidence of a primary or reactivation infection, touch imprints from involved tissue may stain for the presence of EBNA (Epstein-Barr nuclear antigen), and EBV DNA hybridization studies demonstrate the presence of EBV-specific DNA sequences within tumor cells. Since EBV induces a polyclonal B-cell proliferation in vitro and in vivo, the polyclonality of these diseases also implicates EBV. Acyclovir, a new synthetic antiviral agent that inhibits EBV DNA replication may be effective in some patients during the polyclonal growth phase but is ineffective once the tumor evolves into a monoclonal lymphoma. We have identified several factors that may be useful in predicting responsiveness to acyclovir therapy.

Topics: Acyclovir; Adult; Antigens, Viral, Tumor; B-Lymphocytes; Cell Transformation, Neoplastic; DNA; Herpesvirus 4, Human; Humans; Hyperplasia; Kidney Transplantation; Lymphoma; Lymphoproliferative Disorders; Nucleic Acid Hybridization; Transplantation Immunology

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

Topics: Acyclovir; Bone Marrow Transplantation; Humans; Immunosuppression Therapy; Lymphoma; Lymphoproliferative Disorders; Postoperative Complications; Premedication

Topics: Acyclovir; Female; Herpesviridae Infections; Hodgkin Disease; Humans; Leukemia; Lymphoma; Male

Sixty minutes intravenous infusions of Acyclovir were given at 5 to 10 mg/kg 3 times daily for 6 to 11 days in 20 immunodeficient children with varicella (9 cases) and herpes zoster (11 cases) in a controlled open study. Twelve patients had a life-threatening illness. All patients who received therapy before the first 4 days had a more rapid cessation of new vesicles formation and more rapid scarring. Fourteen controlled children had accelerated clearance of viral antigens from vesicles. In 19 cases, virus was no longer isolated after the 3rd day. Eighteen patients recovered within 6 to 10 days. No relapse of varicella zoster virus infections had been observed 1 to 18 months after the end of treatment. Two children with varicellous interstitial pneumonia died 8 and 32 days after the end of treatment. In 3 cases, zoster pains reappeared 8 days after Acyclovir therapy was stopped. The drug was well-tolerated, but control of renal functions is necessary.

Topics: Acyclovir; Adolescent; Antigens, Viral; Chickenpox; Child; Child, Preschool; Female; Fluorescent Antibody Technique; Herpes Zoster; Humans; Immune Tolerance; Infusions, Parenteral; Leukemia; Lymphoma; Male; Neoplasms

Topics: Acyclovir; Antibodies, Viral; B-Lymphocytes; Child; Graft Rejection; Guanine; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Kidney Transplantation; Lymphoma; Male