Creating a culture of support on a bone marrow transplant unit: It takes a village

K.S. Calderon, C.L. Schmid, P.H. Partin-Welch, N.S. Robinson, H. Huber, R.A. Van Loon
2006 Biology of Blood and Marrow Transplantation  
twice daily) from 4 months through 2 years following SCT for the prevention of zoster. VACV is readily converted to acyclovir in vivo following oral administration, has potent activity against VZV, and can be dosed twice daily. Fifty-three VZV-seropositive transplant recipients (17 autologous, 36 allogeneic SCT) were randomized at a median of 163 days following SCT. Using an intent-totreat analysis, the rate of VZV in the VACV arm was 3 of 27 versus 6 of 26 in the placebo arm (P ϭ .21). All
more » ... e cases in the VACV arm occurred after randomization but prior to starting VACV. Using a modified intent-to-treat analysis comprised of those subjects randomized who took any study drug, 49 subjects started the planned therapy with VACV or placebo (4 subjects never started: 2 developed zoster and 2 dropped blood counts prior to the time they were supposed to start; a fifth subject started drug following resolution of zoster starting after randomization). The rate of zoster was 6 of 26 in the placebo arm versus 0 of 23 in the VACV arm (P ϭ .03). Thirty subjects completed the planned therapy through the second year after transplant or first episode of zoster. Reasons for discontinuation in the placebo group included adverse reactions (nausea/vomiting/dehydration in 2 subjects; elevated transaminases, low platelets, and joint pains in 1 subject each) and relapse (4). Reasons in the VACV group included withdrawal of consent (4), relapse (3), and adverse reactions (1 leukopenia, 1 cramping abdominal pain). The 6 episodes of zoster were recorded at a median of 122 days after randomization (278 days after BMT) and were complicated by 3 episodes of post-herpetic neuralgia. Valacyclovir at a dose of 1000 mg twice daily through the second year after transplant is well tolerated and effective in preventing the outbreak of shingles after SCT.
doi:10.1016/j.bbmt.2005.11.426 fatcat:zrdg5racszbqnpl5wdanncdjku