机器人导航辅助CT引导下肺恶性肿瘤放射性粒子植入术的临床应用

摘 要：［目的］ 探讨机器人导航辅助CT引导下在肺恶性肿瘤放射性粒子植入术中的应用价值。［方法］对40例肺恶性肿瘤患者行粒子植入术,比较机器人导航辅助CT引导组（20例）与常规CT引导组（20例）的穿刺次数、扫描次数、精度偏差、治疗时间、DLP以及并发症发生率。［结果］ 机器人导航辅助CT引导组的平均穿刺次数(2.7±1.0 vs 4.3±1.5)、扫描次数(4.7±1.2 vs 6.0±1.4)、精度偏差(3.4±1.3mm vs 6.3±2.1mm )以及DLP值(325.2±104.1 mGy·cm vs 457.5±163.5 mGy·cm)均低于常规CT引导组,差异均具有统计学意义（P均＜0.05）;两组在治疗时间和并发症方面差异无统计学意义（P＞0.05）。［结论］ 机器人导航辅助CT引导下行肺恶性肿瘤放射性粒子植入术的操作精度高、辐射剂量少,安全性好,具有较高的临床应用价值。     

甲状腺乳头状癌合并桥本甲状腺炎中央区阴性淋巴结清扫的临床分析

摘 要：［目的］ 探讨甲状腺乳头状癌(PTC)合并桥本甲状腺炎(HT)患者中央区阴性淋巴结清扫的理论依据及应用策略。［方法］ 回顾性分析294例PTC初治患者术中阴性淋巴结清扫情况,按照有无合并HT分为合并组 (A组)和单纯组(B组)。比较两组病理特征对术中阴性淋巴结清扫的影响。［结果］ 中央区淋巴结转移发生率A组低于B组 ( 43.8% vs 62.4%,P=0.040),淋巴结清扫总数A组多于B组（9.14±2.37 vs 6.75±0.97,P<0.001）,阴性淋巴结清扫数A组多于B组（6.56±0.41 vs 2.83±0.47,P=0.002）。颈淋巴结术后病理阳性率A组低于B组(53.39％ vs 63.11％,P=0.012)。手术时间A组高于B组（82.22 min vs 70.32 min）,手术出血量A组多于B组（37.53±2.47ml vs 22.46±1.31ml,P=0.040）。［结论］认识PTC合并HT患者中央区淋巴结转移特点,合理控制中央区阴性淋巴结清扫数目及范围,可有效降低术后并发症。     

基于TLR4/MyD88/NF-κB信号通路研究右美托咪定对肝癌切除术大鼠免疫功能的影响

摘 要：［目的］ 基于TLR4/MyD88/NF-κB信号通路探讨右美托咪定对肝癌切除术大鼠免疫功能的影响。［方法］ 采用肝包膜下植入肝癌组织建立大鼠原位肝癌模型，并以随机数字表法将24只原位肝癌SD大鼠分为对照组（C组）和右美托咪定低、中、高剂量组（DL组、DM组、DH组），每组6只大鼠。右美托咪定组大鼠于麻醉诱导前15min内静脉输注右美托咪定，麻醉诱导插管后，持续静脉输注右美托咪定至实验结束，对照组则静脉输注等量生理盐水。各组分别于术前（T0）、术后2d（T1）和术后5d（T2）采集尾静脉血。采用流式细胞仪测定T淋巴细胞亚群CD3+、CD4+、CD8+水平，计算CD4+/CD8+；采用ELISA法检测血浆白细胞介素-2（IL-2）、白细胞介素-10（IL-10）、白细胞介素-17A（IL-17A）及干扰素-γ（IFN-γ）的浓度；T2取血后，处死大鼠，观察脾组织病理变化，并运用Western blot检测脾组织中TLR4、MyD88、NF-κB p65蛋白表达。［结果］在T1和T2时，DH组CD3+、CD4+T细胞数量均比C组显著提高(T1：45.80±8.95 vs 26.03±8.45，P＜0.05；19.73±3.23 vs 10.00±2.95，P＜0.01；T2：45.70±5.41 vs 23.77±5.98，15.30±3.15 vs 8.73±2.80，P均＜0.05)，CD8+ T细胞数量则降低，但无显著差异(P>0.05)。IL-2、IL-17A和IFN-γ水平显著提高(T1：53.72±1.32 vs 51.89±1.19，P<0.05；225.16±2.46 vs 216.80±2.77，P＜0.01；1 556.02±20.72 vs 1 528.55±19.77，P<0.05；T2：53.30±1.35 vs 49.93±1.28，P＜0.01；223.57±2.55 vs 211.42±2.61，P<0.01；1 553.81±21.24 vs 1 524.72±15.65，P<0.05)，IL-10水平降低(T1：145.56±1.50 vs 155.36±1.19；T2：148.51±1.39 vs 166.26±2.12，P均＜0.01)。与T0时比较，各组在T1、T2时CD3+、CD4+T细胞数量均降低，CD4+/ CD8+升高，CD8+T细胞数量升高。T2时，C组和DL组的IL-2、IL-17A水平均显著降低（C组：49.93±1.28 vs 56.02±0.98，211.42±2.61 vs 226.77±2.59，P均＜0.01；DL组：50.77±0.83 vs 55.02±1.13，P＜0.01；219.67±2.03 vs 225.82±2.64，P<0.05），IL-10水平显著升高（166.26±2.12 vs 146.28±1.50，155.40±1.57 vs 143.59±1.19，P均＜0.01），各组在T1、T2时IFN-γ水平无显著变化。病理结果显示，与C组相比，右美托咪定组脾脏中成熟淋巴细胞数量增加，白髓面积相对扩大。Western blot结果显示，右美托咪定呈剂量依赖性显著下调TLR4、MyD88和NF-κB p65的表达。［结论］ 右美托咪定可改善原位肝癌切除术大鼠术后细胞免疫功能抑制，可能是通过阻碍TLR4/MyD88/NF-κB信号通路的激活而发挥免疫调节作用。     

MiR-655对结直肠癌细胞奥沙利铂化疗敏感性的影响

摘 要：［目的］ 探讨miR-655对结直肠癌细胞奥沙利铂化疗敏感性的影响。［方法］ 通过qRT-PCR 验证奥沙利铂耐药和敏感结直肠癌组织蜡块中miR-655的相对表达量;CCK-8法检测细胞活性;Transwell检测细胞侵袭能力;流式细胞术检测细胞周期。［结果］ 相比于癌旁的正常组织,对奥沙利铂耐药的结直肠癌组织中miR-655表达量相对较低（1.24±0.28 vs 0.25±0.12,P<0.01）,而对奥沙利铂敏感的结直肠癌组织中miR-655表达量相对较高（1.24±0.28 vs 2.68±0.76,P<0.01）。QRT-PCR鉴定miR-655转染效率结果显示,在miR-655 mimics组中miR-655表达水平相对于miR-NC组显著升高（1.70±0.10 vs 0.83±0.07,P=0.004）。CCK-8检测细胞活性结果显示,与L-OHP/miR-NC组相比,L-OHP/miR-655 mimics组细胞活性降低（48h：0.79±0.05 vs 0.56±0.03,P=0.0015;72h：0.65±0.05 vs 0.25±0.05,P=0.0081）。Transwell法检测细胞的侵袭能力结果显示,与L-OHP/miR-NC组相比,L-OHP/miR-655 mimic组细胞侵袭数量减少（845±85 vs 613±36,P=0.0292）。流式细胞术检测细胞周期结果显示,与L-OHP/miR-NC组G0/G1期相比,L-OHP/miR-655 mimics组细胞比例增加（5.16±0.22 vs 45.53±0.75,P=0.022）,与L-OHP/miR-NC组S期相比,L-OHP/miR-655 mimics组细胞比例降低（44.83±1.17 vs 20.75±0.36,P=0.015）,与L-OHP/miR-NC组G2/M期相比,L-OHP/miR-655 mimics组细胞比例减少(22.86±1.21 vs 3.85±0.35,P=0.0023）。［结论］MiR-655能够提高结直肠癌细胞对奥沙利铂的化疗敏感性,miR-655可能成为联同奥沙利铂治疗结直肠癌的新靶点。     

125I放射性粒子植入联合化疗治疗直肠癌术后辅助放疗后局部复发

目的：评价 CT 引导下125 I 放射性粒子植入术联合 FOLFIRI 方案化疗二线治疗直肠癌术后辅助放疗后局部复发的疗效和安全性。方法34例既往有局部放疗史的直肠癌术后局部复发患者分为2组,对照组仅予 FOLFIRI 方案化疗,研究组予125 I 放射性粒子植入联合 FOLFIRI 方案化疗。术后每2个月参照 RE-CIST 标准评价近期疗效,采用寿命表法计算1、2、3 a 生存率,采用 log rank 法比较亚组生存差异并绘制生存曲线。结果对照组有效率为250%,研究组为1000%（P ＜0001）。中位局部控制时间对照组为4个月,研究组为12个月（P ＜0001）;2组总生存时间分别为19、36个月（P =00168）。结论 CT 引导下125 I放射性粒子植入术联合 FOLFIRI 方案化疗可作为直肠癌术后辅助放疗后局部复发的补救治疗。     

WP1130通过下调β-catenin增强鼻咽癌细胞化疗敏感性

摘 要：［目的］探讨WP1130与顺铂联合用药对鼻咽癌细胞增殖和转移的影响及其可能机制。［方法］ CCK-8法检测鼻咽癌顺铂敏感细胞系HNE1和顺铂耐药细胞系HNE1/DDP的顺铂药物半抑制浓度（IC50）,以及不同浓度WP1130对鼻咽癌细胞活力的影响;选取适当药物浓度处理细胞,两种鼻咽癌细胞系分别分为4组：空白对照组（DMSO）、DDP单药组（6 ?滋mol/L顺铂）、WP1130单药组（1.25 ?滋mol/L WP1130）以及DDP+WP1130联合用药组（6 ?滋mol/L顺铂+1.25 ?滋mol/L WP1130）。MTT法检测鼻咽癌细胞增殖能力;细胞划痕实验检测鼻咽癌细胞迁移能力;Transwell侵袭实验检测鼻咽癌细胞侵袭能力;RT-PCR和Western blot实验检测顺铂耐药HNE1/DDP与亲本HNE1鼻咽癌细胞中β-catenin的表达情况以及不同药物处理对β-catenin的表达的影响。［结果］ 耐药HNE1/DDP细胞比亲本HNE1细胞对顺铂的耐受性提高了近5.7倍（5.17±0.33 vs 29.44±2.62,P＜0.01）。β-catenin在HNE1/DDP细胞中的mRNA表达上调约3.4倍（1.00±0.26 vs 3.44±0.39,P＜0.01）。与空白对照组和单药组相比,顺铂+WP1130联合用药组细胞中β-catenin的表达显著下调（HNE1：1.00±0.06 vs 0.78±0.07 vs 0.32±0.05,P＜0.05;HNE1/DDP：1.01±0.05 vs 0.57±0.07 vs 0.39±0.07,P＜0.05）,顺铂+WP1130联合用药组细胞增殖、迁移和侵袭能力均显著下降（P均＜0.01）。［结论］ WP1130与顺铂联合用药可以通过下调β-catenin的表达增强顺铂对细胞增殖、迁移和侵袭的抑制作用,从而增强鼻咽癌细胞的化疗敏感性。     

乳腔镜辅助保留乳头乳晕复合体的乳腺癌改良根治术安全性及改善生活质量作用分析

摘 要：［目的］ 探讨乳腔镜辅助保留乳头乳晕复合体（NAC）的乳腺癌改良根治术（NSM）的肿瘤学安全性及在改善患者生活质量中的作用。［方法］ 收集294例乳腺癌患者的临床资料,其中乳腔镜辅助NSM 观察组192例,同期行开放乳腺癌改良根治术（MRM）对照组103例,分析患者预后和生存情况,并采用乳腺癌患者生命质量测定量表（FACT-B）对两组患者生活质量进行测评。［结果］ 观察组复发转移29例,死亡11例,3、5年及总无病生存率（DFS）分别为95.0%、84%、84.9%,3、5年及总生存率（OS）分别98.3%、93.3%、94.3%;对照组复发转移12例,死亡5例,3、5年及总DFS分别为95.8%、93.2%、88.3%,3、5年及总OS分别为98.6%、93.2%、95.1%;两组DFS、OS差异均无统计学意义（P均＞0.05）。除心理状况外,观察组患者生活质量各项指标均高于对照组患者（心理状况：18.800±4.383 vs 19.200±4.088, P=0.437;社会家庭状况：21.110±1.807 vs 20.640±1.862,P=0.034;情感状况：19.580±2.950 vs 17.350±2.367,P<0.001;功能状况：21.570±2.418 vs 20.89±2.191,P=0.018;附加关注：25.580±2.123 vs 21.900±2.286,P＜0.001）。［结论］ 对于早期乳腺癌患者,乳腔镜辅助NSM可保证肿瘤学安全性,并提高术后生活质量。     

华蟾素片联合125I粒子植入术治疗晚期原发性肝癌疗效及对相关血液生化指标的影响

目的:探讨华蟾素片联合放射性125I 粒子植入术对晚期原发性肝癌患者术后外周血T淋巴细胞亚群及血清甲胎蛋白（AFP）、癌胚抗原（CEA）水平变化的影响。方法:选取2012年4月至2017年2月我院84例晚期原发性肝癌患者,随机数字表法分为对照组（n=42）与研究组（n=42）,另选取同期于我院进行健康体检者42例设为健康组。对照组采用放射性125I 粒子植入术,研究组采用放射性125I 粒子植入术+华蟾素片,持续治疗4周。治疗结束后统计对比两组临床疗效、不良反应发生率、并发症发生率,入院时及疗程结束后对比三组外周血T淋巴细胞亚群（CD3+、CD4+、CD8+、CD4+/CD8+）、血清AFP、CEA水平、生存周期。结果:两组临床疗效比较,研究组与对照组间无明显差异（P＞0.05）。治疗前后三组血清CD3+、CD4+、CD8+、CD4+/CD8+水平比较存在明显差异（P＜0.05）,且研究组CD3+、CD4+、CD4+/CD8+水平较对照组高,CD8+水平较对照组低（P＜0.05）。治疗前后三组血清AFP及CEA水平相比存在明显差异（P＜0.05）,治疗后研究组血清AFP及CEA水平较对照组低（P＜0.05）。研究组骨髓抑制、白细胞减少、胃肠道反应、脱发发生率较对照组低,但无明显差异（P＞0.05）。两组并发症发生率比较,研究组与对照组［9.52%（4/42） vs 14.29%（6/42）］无明显差异（P＞0.05）。研究组平均生存期及中位生存期较对照组长（P＜0.05）。结论:联合采用华蟾素片及放射性125I 粒子植入术治疗晚期原发性肝癌效果显著,可增强患者机体免疫功能,降低血清CEA、AFP水平,且不良反应及并发症较少,具有安全性。     

食管癌合并腹腔淋巴结转移术中植入125I放射性粒子的临床疗效

摘 要：［目的］ 探讨食管癌合并腹腔淋巴结转移患者术中植入碘125粒子的临床疗效。［方法］ 回顾性分析了2010~2013年行手术治疗的83例术中及术后病理证实存在腹腔淋巴结转移的食管癌患者,44例行常规根治术术中在腹腔淋巴结区域（主要是胃左区域）植入碘125粒子,39例患者仅采取常规方式手术,分析对比两组患者术后并发症等临床资料及随访资料。［结果］ 两组在手术时间、住院时间、吻合口瘘、发热、排气时间及膈疝比较均无统计学意义(P>0.05);碘125粒子组1年、2年局部复发率分别为20%、36%,明显低于对照组的41%及59%（P<0.05）。植入碘125粒子组1年生存率与对照组相比无明显差异（88% vs 83%,P>0.05）,但2年生存率为66%,明显高于对照组的44%（P<0.05）。［结论］ 碘125粒子能有效减少食管癌腹腔淋巴结转移患者局部复发率,提高生存率,不增加手术时间及并发症发生率。     

阿瑞匹坦预防阿霉素联合异环磷酰胺方案化疗后呕吐的临床观察

摘 要：［目的］ 观察阿瑞匹坦预防阿霉素联合异环磷酰胺（AI）方案化疗后呕吐的疗效及安全性。［方法］ 将接受AI化疗方案的80例骨肉瘤和软组织肉瘤患者随机分为两组,阿瑞匹坦组予以三联（阿瑞匹坦、帕诺洛司琼、地塞米松）止吐方案、对照组予以二联（帕洛诺司琼、地塞米松）止吐方案,比较两组患者恶心、呕吐的控制情况,同时观察阿瑞匹坦的不良反应。［结果］ 急性观察期,阿瑞匹坦组和对照组的完全缓解(complete response,CR) 率分别为84.6%和63.4%（P＜0.05）;迟发性观察期,阿瑞匹坦组CR率高于对照组（74.4% vs. 51.2%,P＜0.05）;在总观察期,阿瑞匹坦组CR率亦显著性高于对照组（69.2% vs. 46.3%,P＜0.05）;而两组的不良反应发生率无明显差异（P＞0.05）。［结论］ 阿瑞匹坦联合帕洛诺司琼及地塞米松能有效预防AI化疗方案引起的恶心呕吐,且不良反应可耐受。     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.