acyclovir and Precursor-Cell-Lymphoblastic-Leukemia-Lymphoma

Serious ocular disease following varicella (chickenpox) is rare in children. In addition, retinitis in children with hematologic malignancies may present a difficult diagnostic challenge because infectious retinitis may mimic leukemic involvement of the eye. We report a 7-year-old patient with T-cell acute lymphoblastic leukemia in remission who presented with visual complaints 2 weeks after developing chickenpox. Ophthalmologic evaluation revealed acute retinitis in the right eye. Prolonged therapy with acyclovir resulted in near complete recovery. Early diagnosis of VZV retinopathy and aggressive antiviral treatment is critical to prevent acute and long-term ocular sequelae.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Child; Diagnosis, Differential; Humans; Leukemia, T-Cell; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retinitis

Blistering disorders in childhood are usually difficult to diagnose and pose complicated management dilemmas. The incidence of herpes zoster in children with malignancy and immunodeficiency is greatly increased compared to normal children of comparable age. Although herpes zoster is known to occur in children with malignancy, the bullous form of herpes zoster is rare; to the authors' knowledge, there was no previous report of this phenomenon in children in general and in children with cancer in particular. The authors describe a 3.5-year-old girl who was diagnosed with acute lymphoblastic leukemia; 7 months after presentation, during chemotherapy treatment, she developed the bullous form of herpes zoster on her right hand. The authors describe the method of diagnosis and provide a review of the literature concerning this rare phenomenon. Recognizing this entity and differentiating it from other bullomatous conditions enable the application of appropriate treatment, without unnecessary delay.

Topics: Acyclovir; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Child, Preschool; DNA, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Polymerase Chain Reaction; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Skin Diseases, Vesiculobullous

Topics: Acyclovir; Animals; Antiviral Agents; Ganciclovir; Herpes Simplex; Humans; Leukemia, Myeloid; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Tumor Cells, Cultured

A 41 year old female developed reactive haemophagocytic histiocytosis secondary to herpes simplex infection, during remission induction for acute lymphoblastic leukaemia. She recovered fully with acyclovir and supportive treatment. Previous publications on the association between acute lymphoblastic leukaemia and haemophagocytic syndrome are reviewed, and the nature of the haemophagocytic disorder is discussed.

Topics: Acyclovir; Adult; Female; Herpes Simplex; Histiocytic Sarcoma; Humans; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Remission Induction

Topics: Acyclovir; Child; Encephalitis; Female; Herpesviridae Infections; Humans; Precursor Cell Lymphoblastic Leukemia-Lymphoma

We prospectively tested the hypothesis that prevention of herpes simplex virus infection with acyclovir might also reduce the incidence of bacterial infections in adult patients with acute leukaemia. During the first induction therapy a double-blind, randomized and placebo-controlled study was undertaken. Fifty-two patients were treated with 200 mg acyclovir orally four times daily throughout the induction period, whereas 55 patients received placebo. The groups were comparable with regard to age, cytotoxic chemotherapy and duration of neutropenia. Bacteraemias were significantly fewer in the acyclovir group (20 versus 41 episodes; P = 0.007). The number of isolated microorganisms causing bacterial or fungal infections was also lower during acyclovir prophylaxis (52 isolates, versus 93 isolates; P = 0.02). There was no significant difference between the groups with regard to the number of clinically documented infections or fevers of unknown origin. Herpes simplex virus isolations occurred only in the placebo group (P = 0.001). Thus, oral acyclovir prophylaxis was associated with reductions of all microbiologically documented infections suggesting that prevention of herpes simplex virus reactivation in acute leukaemia patients may reduce the occurrence of other infections.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Bacteremia; Bacterial Infections; Double-Blind Method; Fever; Herpes Simplex; Humans; Incidence; Ketoconazole; Middle Aged; Mycoses; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prospective Studies

A 2.5-year-old boy presented to his pediatrician with progressive pallor, asthenia, fever, splenomegaly, and hematomas. Leukemia was suspected, and a bone marrow aspirate confirmed acute lymphoblastic leukemia. Before chemotherapy induction, the child developed a vesicular rash and was diagnosed clinically with chickenpox. Acyclovir treatment was initiated immediately, whereas induction chemotherapy was postponed by 10 days. At the time of chickenpox resolution, a spontaneous partial recovery of his blood counts and a 50% decrease of blastic bone marrow infiltration were noted. After a brief nonsystematic review, we discuss the potential beneficial effect of acyclovir and chickenpox infection in children with leukemia.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Child, Preschool; Herpesvirus 3, Human; Humans; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Remission, Spontaneous

We report a case of cytomegalovirus encephalitis in a hematopoietic stem cell transplant recipient. A previously uncharacterized V787E mutation in UL54 was identified in cerebrospinal fluid but not plasma specimens. For the V787E recombinant virus, the half maximal effective concentrations for ganciclovir, foscarnet, and cidofovir were 8.6-, 3.4- and 2.9-fold higher than for wild-type virus, and the replicative capacity was lower. The introduction of a bulkier and negatively charged glutamate residue at position 787 could destabilize the finger domain of UL54 DNA polymerase. Viral genotyping of cerebrospinal fluid is warranted in subjects with cytomegalovirus encephalitis, owing to the low penetration of antivirals in this compartment.

Topics: Acyclovir; Antibiotic Prophylaxis; Antiviral Agents; Cerebrospinal Fluid; Cytomegalovirus; Cytomegalovirus Infections; Drug Resistance, Multiple, Viral; Encephalitis, Viral; Female; Graft Rejection; Hematopoietic Stem Cell Transplantation; Humans; Immediate-Early Proteins; Immunosuppression Therapy; Middle Aged; Mutation; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Viral Proteins

Topics: Acyclovir; Anal Canal; Antiviral Agents; Child; Herpes Zoster; Humans; Male; Perineum; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Topics: Acyclovir; Adolescent; Antiviral Agents; Bell Palsy; Central Nervous System Neoplasms; Facial Nerve; Humans; Magnetic Resonance Imaging; Male; Optic Nerve Diseases; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Recovery of Function; Recurrence; Spinal Puncture; Treatment Outcome; Valacyclovir; Valine

A 5-year-old girl with precursor B-cell acute lymphoblastic leukemia developed peripheral-type right facial palsy and very faint erythema on her right pinna during maintenance therapy. Acyclovir was started for possible zoster infection. The following day, vesicles appeared and a diagnosis of Ramsay Hunt syndrome was made. Prednisolone was started on day 5 after onset. Her facial palsy recovered within 6 months. Ramsay Hunt syndrome is a rare cause of facial palsy in patients with acute lymphoblastic leukemia, and this is the first case report. Preemptive therapy with acyclovir before the development of vesicles should help the patient recover from facial palsy.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Female; Herpes Zoster Oticus; Humans; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Varicella is a common and mild disease in healthy children. However, when patients are in immunocompromised conditions, such as receiving chemotherapy for cancer treatment, they are highly vulnerable and it can even prove lethal. Herein, we report a 14-year-old boy with acute lymphoblastic leukemia who was receiving chemotherapy for induction with vincristine, idarubicin, L-asparaginase, and prednisolone, presented with typical varicella skin lesions and varicella-zoster virus was detected in his serum by real-time polymerase chain reaction (PCR). His condition was advanced to multiple organs failure, including fulminant hepatitis, disseminated intravascular coagulation, and myocarditis despite acyclovir administration. After a combined therapy with intravenous acyclovir and high-dose intravenous immunoglobulin, his condition was dramatically improved. We suggest that IVIG may be used immediately with acyclovir when immunocompromised patients with varicella advanced to dissemination are identified.

Topics: Acyclovir; Adolescent; Antiviral Agents; Chickenpox; Combined Modality Therapy; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Male; Multiple Organ Failure; Precursor Cell Lymphoblastic Leukemia-Lymphoma

We report a case of a potential drug-drug interaction in a woman treated by a first injection of high-dose methotrexate for a T-lymphoblastic lymphoma. Valaciclovir, fluoxetine and pantoprazole were given concomitantly. A methotrexate overdosage was shown at 36 h after infusion associated with a severe renal failure. Alkaline hyperhydration, folinic acid and carboxypeptidase G2 were given. Prescription analyses by pharmacists and literature research have permitted us to suggest that a drug-drug interaction between methotrexate and proton pump inhibitors (PPI) was responsible for this renal failure. Several mechanisms of interaction were suggested and might be related to the inhibition of renal methotrexate transporters by PPI, an increase in the methotrexate efflux to the blood by an upregulation of multidrug resistance protein 3 by PPI or genetic polymorphisms. This case shows that pharmacists can help physicians to optimize patient treatment: they consensually decided on the systematic discontinuation of PPI or a switch to ranitidine when patients were treated by high-dose methotrexate.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Acyclovir; Antimetabolites, Antineoplastic; Antiviral Agents; Drug Interactions; Female; Fluoxetine; Humans; Methotrexate; Middle Aged; Pantoprazole; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Proton Pump Inhibitors; Renal Insufficiency; Valacyclovir; Valine

Meningitis or encephalitis by varicella-zoster virus (VZV) after hematopoietic stem cell transplantation (HSCT) is rarely reported. We encountered a case of meningoencephalitis with VZV re-activation 18 months after related bone marrow transplantation for recurrent acute lymphoblastic leukemia. The patient had been administered steroid and cyclosporine for chronic graft-versus-host disease. A high DNA copy number of VZV, 4.9×10(7) copies was detected in the cerebrospinal fluid. VZV also caused severe pneumonia and acute renal failure soon after the onset of meningoencephalitis. The patient was successfully treated with acyclovir, although he was left with persistent neurological sequelae. Both prompt diagnosis and early treatment of VZV reactivation are important to avoid a fatal outcome.

Topics: Acute Kidney Injury; Acyclovir; Adult; Antiviral Agents; Bone Marrow Transplantation; Chronic Disease; Cyclosporine; Encephalitis, Varicella Zoster; Graft vs Host Disease; Herpesvirus 3, Human; Humans; Immunosuppressive Agents; Male; Pneumonia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Recurrence; Time Factors; Virus Activation

Topics: Acyclovir; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Child; Female; Hair Diseases; Humans; Immunosuppressive Agents; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Remission, Spontaneous; Trimethoprim, Sulfamethoxazole Drug Combination

Herpes zoster rarely occurs in healthy children, but may occur frequently and may take a complicated course in children receiving chemotherapy. We aimed to assess morbidity from herpes zoster in children with acute lymphoblastic leukemia (ALL).. Reviewing records, treatment and course of zoster eruptions were registered in a cohort of 67 children with newly diagnosed ALL. Of these, 45 had had varicella at the time of diagnosis and 15 contracted varicella or were vaccinated during the course of therapy.. Eleven children had a total of 17 eruptions while receiving chemotherapy. All eruptions were treated with acyclovir, in eight cases intravenously, and in six cases chemotherapy was interrupted. Cutaneous dissemination occurred in two cases, visceral dissemination in none. One child had postherpetic trigeminal neuralgia for two months. The eruption rate was higher among small children than among school-aged children (0.22 vs. 0.13 per year of chemotherapy) and was related to the intensity of chemotherapy (0.30 per year of consolidation treatment vs. 0.13 for maintenance therapy). Three children on prolonged intensive chemotherapy had recurrent zoster episodes.. Chemotherapy causes zoster eruptions in approximately one quarter of children with ALL, and with intensive protocols recurrent zoster can cause significant morbidity. Attempts to improve immunity by vaccine boosting after attaining remission seems warranted.

Topics: Acyclovir; Adolescent; Antineoplastic Agents; Antiviral Agents; Chickenpox; Child; Child, Preschool; Cohort Studies; Herpes Zoster; Humans; Immunocompromised Host; Infant; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Risk Factors

In children with cancer, varicella can be complicated by visceral dissemination with a risk of fatal outcome, especially in children with acute lymphoblastic leukaemia (ALL). Immunoprophylaxis and antiviral therapy have reduced the mortality, but the morbidity remains significant and is explored here in a cohort of children with ALL.. Among 67 children diagnosed with ALL during 1992-2007, 22 were seronegative for varicella-zoster virus (VZV) at the time of diagnosis. Patient records were reviewed to describe varicella exposures, eruptions and vaccinations during chemotherapy (24-30 months) and the following six months of immune recovery.. Fifteen exposures were recognised in eight children and were managed with oral acyclovir prophylaxis; three resulted in clinical infection. Adoption of brief prophylaxis in the second week of incubation has not - so far - increased the infection rate (one in six versus two in nine). A further six varicella cases occurred without recognised exposure. All nine eruptions (in eight children) were uncomplicated but entailed hospitalisation days for intravenous therapy with acyclovir and loss of chemotherapy days. Seven children were VZV-vaccinated during maintenance chemotherapy; none developed varicella or zoster later in the course.. Despite protective isolation and prophylactic treatment, seronegative children with ALL have a high risk of varicella during or shortly after chemotherapy. We recommend that susceptible siblings should be vaccinated at the time of diagnosis and the child should receive vaccination once oral maintenance chemotherapy has been initiated.

Topics: Acyclovir; Adolescent; Antineoplastic Agents; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Child; Child, Preschool; Cohort Studies; Humans; Immunocompromised Host; Infant; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Risk Factors

Topics: Acyclovir; Antiviral Agents; Biopsy; Hepatitis, Viral, Human; Herpes Simplex; Humans; Male; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Radiography; Treatment Outcome

Reactivation of latent varicella zoster virus is one infectious complication associated with the extensive immunosuppression necessary for hematopoietic stem cell transplant. Most cases are limited to skin and mortality is low. Isolated visceral zoster is rare, presenting with ileus/abdominal pain, hepatitis, and/or hyponatremia. We present 2 cases of visceral varicella zoster virus in adolescents with chronic graft-versus-host disease after hematopoietic stem cell transplant. Both presented with elevated liver enzymes, severe abdominal pain, and hyponatremia but lacked cutaneous involvement. Both received high-dose acyclovir and showed improvement, but eventually expired from hepatic failure. The diagnosis of visceral zoster can be difficult especially without cutaneous manifestations. Vigilance is necessary in patients with chronic graft-versus-host disease, abdominal pain, and/or hepatitis and antiviral therapy should be initiated promptly.

Topics: Acyclovir; Antiviral Agents; Chronic Disease; Fatal Outcome; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Leukemia, Myeloid, Acute; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Transplantation, Homologous; Virus Activation; Viscera; Young Adult

We describe a patient with acute lymphocytic leukemia (ALL) who developed visceral varicella-zoster virus (VZV) infection following cord blood stem cell transplantation (CBSCT) and was successfully treated with intravenous acyclovir (ACV). A 24-year-old woman with ALL developed severe epigastric pain 168 days after CBSCT, followed by blistering eruptions 2 days later. A diagnosis of visceral varicella-zoster disease was made, and early intravenous ACV therapy successfully alleviated the epigastric pain and skin lesions within 2 weeks. Polymerase chain reaction analysis of the serum showed dramatic decreases in the viral DNA copy number and revealed large viral concentrations prior to the skin manifestations. The viral DNA copy number in whole blood remained positive, however, but was reduced. Further treatment with intravenous ACV led to VZV DNA becoming undetectable in whole blood, a result not achieved with oral valacyclovir.

Topics: Acyclovir; Adult; Antiviral Agents; Cord Blood Stem Cell Transplantation; DNA, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Injections, Intravenous; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Viscera

HSV causes serious complications in immunocompromised patients, especially SCT recipients. Although ACV is an effective antiviral prophylaxis, the emergence of ACV resistance is a growing problem. The authors describe two cases of fatal ACV-resistant HSV in two pediatric patients following unrelated donor SCT. Despite the in vitro sensitivity of the HSV isolates to foscarnet, both patients failed to respond to foscarnet therapy. Other antiviral therapies should be considered in those patients who fail to show rapid clinical improvement.

Topics: Acyclovir; Adolescent; Antiviral Agents; Child; Drug Resistance, Viral; Fatal Outcome; Female; Follow-Up Studies; Herpes Simplex; Humans; Pneumonia, Viral; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Stem Cell Transplantation

A 43-year-old Japanese woman underwent unrelated cord blood transplantation (CBT) during remission for acute lymphoblastic leukemia with t(4; 11)(q21;q23). Tacrolimus was given for prophylaxis of graft-versus-host disease. The posttransplantation clinical course was mostly uneventful, and the leukemia remained in remission. Fourteen months after CBT, the patient developed pancytopenia and hepatic dysfunction with persistent high-grade fever. The bone marrow was hypocellular with increased numbers of macrophages and hemophagocytes. The numbers of Epstein-Barr virus (EBV) copies in peripheral blood samples were remarkably high. Although the patient showed complete donor-type hematopoiesis, the titer of viral capsid antigen immunoglobulin G was low, and the results of a test for EBV nuclear antigen were negative. There was no clinical response to the reduction of immunosuppressive therapy or to the administration of high-dose methylprednisolone, human immunoglobulin, or acyclovir. The patient died 466 days after CBT of massive gastrointestinal hemorrhage due to bone marrow and hepatic failures. This case demonstrates that fatal EBV-associated hemophagocytic syndrome (HPS) can occur more than 1 year after CBT. This report is the first of a case of late-onset EBV-associated HPS following CBT.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antibodies, Viral; Antiviral Agents; Bone Marrow Diseases; Epstein-Barr Virus Infections; Epstein-Barr Virus Nuclear Antigens; Female; Hematopoiesis; Hemorrhage; Herpesvirus 4, Human; Humans; Immunoglobulin G; Liver Failure; Lymphohistiocytosis, Hemophagocytic; Methylprednisolone; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Time Factors; Transplantation Chimera

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Eye Infections, Viral; Herpesvirus 3, Human; Humans; Laser Coagulation; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Retinal Necrosis Syndrome, Acute; Stem Cell Transplantation; Transplantation, Homologous; Valacyclovir; Valine

Topics: Acyclovir; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Daunorubicin; Female; Herpes Simplex; Humans; Leukemia, B-Cell; Middle Aged; Pneumonia, Viral; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Simplexvirus; Vincristine

West Nile Virus (WNV) infection is an important cause of encephalitis. Although the medical literature contains examples of WNV encephalitis in susceptible, mainly elderly, immunocompromised hosts, few case reports have described pediatric cases. The authors describe an adolescent with acute lymphocytic leukemia and WNV encephalitis. Surveillance studies indicate an increase in WNV activity. Physicians need to be aware of WNV activity in their community and consider WNV as a potential source of infection.

Topics: Acyclovir; Adolescent; Animals; Antibodies, Viral; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Brain; Ceftazidime; Ceftriaxone; Culicidae; Diagnosis, Differential; Encephalitis, Viral; Fatal Outcome; Humans; Immunoglobulins, Intravenous; Insect Bites and Stings; Magnetic Resonance Imaging; Male; Mercaptopurine; North Carolina; Persistent Vegetative State; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Vancomycin; Vincristine; Virginia; West Nile Fever; West Nile virus

The aim of this study was to determine the incidence and outcome of herpes zoster hospitalised children with cancer in Kota Baru. It was a retrospective review from January 1994 to December 1998. The diagnosis of herpes zoster was a clinical one. Herpes zoster was diagnosed in 10 of 188 (5%) children with malignancy. The most common malignancy was leukaemia. Nine children were treated with acyclovir. No child developed visceral dissemination and there were no deaths.

Topics: Acyclovir; Antiviral Agents; Burkitt Lymphoma; Child; Child, Preschool; Female; Herpes Zoster; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Malaysia; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Treatment Outcome

A leukemic child developed recurrent herpes simplex virus lesions shortly after receiving a bone marrow transplant and while taking acyclovir. The isolate was resistant to acyclovir and foscarnet in vitro. The lesions responded to a course of cidofovir.

Topics: Acyclovir; Antiviral Agents; Bone Marrow Transplantation; Child; Cidofovir; Cytosine; Drug Resistance, Multiple, Viral; Female; Foscarnet; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunocompromised Host; Injections, Intravenous; Organophosphonates; Organophosphorus Compounds; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Stomatitis

Cutaneous lesions arising in herpes zoster (HZ) scars are rare. We report a 34-year-old woman with acute lymphoblastic leukemia underwent allogenic bone marrow transplant (BMT). Ten days after the BMT, she developed clusters of vesicles over the right neck, scapula, shoulder and chest. She was treated with intravenous acyclovir and foscarnet. One month after the vesiculous episode of HZ she showed 5 mm to 2 cm clustered flat violaceous lichenoid papules and confluent plaques within the HZ scars. Histopathologic examination revealed a inflammatory infiltrate present in the papillary dermis with granulomatous aggregated formed by histiocytes, multinucleated giant cells and lymphocytes. She was treated with topic steroids with significant improvement. Pathologic findings are similar to those of an unusual lichenoid reaction named "giant cell lichenoid dermatitis". We present the first reported case of giant cell lichenoid dermatitis at the sites of HZ scars.

Topics: Acyclovir; Adult; Antiviral Agents; Bone Marrow Transplantation; Cicatrix; Dermatitis; Female; Foscarnet; Giant Cells; Glucocorticoids; Graft vs Host Disease; Herpes Zoster; Humans; Lichenoid Eruptions; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Topics: Acyclovir; Administration, Oral; Adolescent; Antiviral Agents; Child; Child, Preschool; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Chickenpox; Female; Humans; Immunocompromised Host; Infant; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Acyclovir (ACV), a nucleoside analog, has been demonstrated previously to suppress selectively the proliferation of NIH3T3 fibroblastic cells transformed by either v-abl or bcr-abl gene transfection. From a viewpoint of clinical application of ACV, we investigated whether ACV inhibited the growth of leukemia cells expressing either p210 BCR-ABL or p185BCR-ABL. Acyclovir exerted an inhibitory effect on OM9;22 cells, p185BCR-ABL expressing cells, in a dose-dependent manner. Despite no down-modulation of a BCR-ABL tyrosine kinase activity or its expression was observed after treatment with ACV, cell cycle analysis demonstrated synchronization of OM9;22 cells at the G0/G1 phase. This suggests that, although ACV does not directly act on BCR-ABL tyrosine kinase, ACV may exert its inhibitory effect on some leukemia cell lines via alterations of the cell cycle. Although selective inhibition of Philadelphia chromosome-positive leukemia cell growth was not apparent, our data provides a therapeutic possibility for ACV in the treatment for leukemia.

Topics: Acyclovir; Antimetabolites, Antineoplastic; Cell Division; Evaluation Studies as Topic; Fusion Proteins, bcr-abl; G1 Phase; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Resting Phase, Cell Cycle; Thymidine Kinase; Tumor Cells, Cultured

Primary varicella-zoster virus infection in children with haematological malignancy is a life threatening disease. In one year, there were 10 cases of varicella and 2 cases of zoster among these children as well as 5 mothers who were accompanying their children who developed varicella in the oncology ward. Two children died of fulminating disease despite aggressive antiviral and supportive treatment. Acyclovir can be used in treatment and prophylaxis in exposed susceptible children. Varicella -zoster immune globulin is not available in this country. Vaccination with live virus has been shown to be protective in immunocompromised children and needs consideration.

Topics: Acute Disease; Acyclovir; Chickenpox; Chickenpox Vaccine; Child; Child, Preschool; Cross Infection; Disease Outbreaks; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Infection Control; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Myeloid; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Severity of Illness Index; Survival Rate; Treatment Outcome; Vaccines, Attenuated; Viral Vaccines

Topics: Acyclovir; Adolescent; Brain; Herpes Zoster; Herpesvirus 3, Human; Humans; Leukoencephalopathy, Progressive Multifocal; Magnetic Resonance Imaging; Male; Microscopy, Electron; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Tomography, X-Ray Computed

Twenty-one adult patients with acute leukemia who underwent autologous blood stem cell transplantation (ABSCT) and who received acyclovir during the first 6 months after transplant to prevent varicella zoster virus (VZV) infection were studied retrospectively to determine the incidence and outcome of VZV infection after ABSCT. The cumulative risk of VZV infection was 32% by 1 year after transplant. No patient developed VZV while on prophylactic acyclovir but five (24%) had localized herpes zoster within 1 month of acyclovir withdrawal. There were no deaths related to VZV infection and only one patient had disseminated disease and post-herpetic neuralgia. These preliminary results suggest that the incidence and outcome of VZV infection after ABSCT largely parallel those reported in marrow transplant patients and that long-term acyclovir prophylaxis delays but does not prevent VZV infection. Prophylaxis of VZV infection after ABSCT requires new therapeutic approaches.

Topics: Acyclovir; Adolescent; Adult; Blood Transfusion; Bone Marrow Transplantation; Combined Modality Therapy; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Leukemia; Leukemia, Myeloid, Acute; Male; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Time Factors; Transplantation, Autologous

Abdominal and back pain has until now been reported as a first sign of severe varicella in immunocompromised children only. We report two adult leukemia patients in whom these symptoms preceded visceral dissemination of varicella infection. Recognizing that this syndrome may occur in adult patients is of clinical importance, since it allows early diagnosis and treatment of the infection.

Topics: Abdominal Pain; Acyclovir; Adult; Back Pain; Chickenpox; Humans; Immunocompromised Host; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma

A 17-year-old male patient with T-cell type lymphoblastic lymphoma in complete remission underwent high dose chemotherapy (busulfan 16 mg/kg and cyclophosphamide 120 mg/kg) followed by autologous bone marrow transplantation (ABMT). The patient had been taking oral acyclovir (200 mg x 5) daily from seven days prior to the ABMT (day -7). On day +24, he complained of epigastralgia and general malaise, and the next day his GOT and GPT rose to 570 U/l and 397 U/l, respectively. Although he had no mucocutaneous lesions, hepatitis caused by a herpes virus was suspected, and high dose intravenous acyclovir (10 mg/kg x 3/day) was immediately started. His GOT, GPT and total bilirubin reached peaks of 2,870 U/l on day +26, 1,830 U/l on day +27 and 10.3 mg/dl on day +39, respectively, and rapidly improved thereafter. Serological analyses on IgG antibody titers to herpes simplex virus type 1 using an enzyme-linked immunosorbent assay revealed specific increases (454-fold before transplantation to 3,830-fold on day +46). Antiviral antibody titers to cytomegalovirus, varicella-zoster virus and Epstein-Barr virus showed no significant changes. The serologic markers of hepatitis B virus, hepatitis A virus and hepatitis C virus were all negative. The results indicate the patient's severe icteric hepatitis to have been caused by a reactivation of herpes simplex virus type 1 due to immunosuppression after high dose chemotherapy with ABMT. It is suggested that prompt commencement of high dose intravenous acyclovir is required to treat severe herpes simplex virus hepatitis affecting immunocompromised patients.

Topics: Acyclovir; Adolescent; Bone Marrow Transplantation; Hepatitis, Viral, Human; Herpes Simplex; Humans; Infusions, Intravenous; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Transplantation, Autologous

Topics: Abdominal Neoplasms; Acyclovir; Child, Preschool; Female; Heart Transplantation; Humans; Intestinal Neoplasms; Intestine, Small; Lymph Nodes; Lymphoma, B-Cell; Lymphoma, Non-Hodgkin; Neoplasm Invasiveness; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Topics: Acyclovir; Chickenpox; Child; Child, Preschool; Female; Humans; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma

One hundred and four patients with acute leukemia treated by allogeneic bone marrow transplantation in Japan were analysed for the incidence of interstitial pneumonitis (IP). Thirty-six (35%) of 104 marrow graft recipients developed IP. Cytomegalovirus (CMV) was the most frequent organism (61%). Using multivariate analysis, remission at transplant (P = 0.0001) and use of cyclosporin A to prevent graft-versus-host disease (P = 0.0363) were found to be significant factors associated with a decreased incidence of IP. For preventing IP, anti-CMV hyperimmune globulin was effective, while interferon and acyclovir were not.

Topics: Acyclovir; Adolescent; Adult; Bone Marrow Transplantation; Child; Child, Preschool; Female; Humans; Immune Sera; Immunoglobulins; Immunoglobulins, Intravenous; Interferons; Japan; Leukemia, Myeloid, Acute; Male; Middle Aged; Patient Isolation; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pulmonary Fibrosis; Transplantation, Homologous