Although
acyclovir prophylaxis against varicella zoster virus (VZV)
infection for ≥1 year is recommended after allogeneic hematopoietic
cell transplantation (HCT), the emergence of
acyclovir-resistant viruses and adverse drug effects cannot be ignored. We investigated the cumulative incidence of VZV
infection after allogeneic HCT in children receiving a shorter duration of
acyclovir prophylaxis than recommended and evaluated the appropriateness of the short duration of
acyclovir prophylaxis.Medical records of 217 children who received allogeneic HCT were retrospectively reviewed until a median of 25 months (range = 1-59 months) after HCT.
Acyclovir prophylaxis was given for a median of 9 weeks (range = 3-24 weeks) after HCT.VZV
infection was diagnosed in 33 (15.2%) children at a median time of 5 months (range = 2-41 months) after HCT. The 1-year and 2-year cumulative incidences of VZV
infection after allogeneic HCT were 11.2% and 15.5%, respectively. These incidences were between the previously reported 1-year incidence of 25% to 30% in patients not receiving prophylaxis and 1-year incidence of 4% to 5% in patients receiving ≥1 year duration of prophylaxis. Male sex and older age were significantly associated with VZV
infection after allogeneic HCT. Only 1
chickenpox patient experienced severe complications because of VZV
infection, and there were no deaths attributable to VZV
infection.In conclusion, a shorter duration of
acyclovir prophylaxis may be appropriate for children receiving allogeneic HCT, based on the rare occurrence of severe complications because of VZV
infection and the expected discomfort because of daily oral medication for a long time.