871 ACYCLOVIR THERAPY OF PRIMARY VARICELLA IN LEUKEMIA

Abstract

Acyclovir [9-(2-hydroxyethoxymethyl)guanine] is an acyclic nucleoside analogue with in vitro activity against herpesviruses including varicella-zoster virus. Acyclovir has had little toxicity except for occasional bullae secondary to drug extravasation. We report our uncontrolled experience with this agent in four children with acute lymphocytic leukemia in remission and disseminated primary varicella with involvement of liver, lungs, CNS, and evidence of myelosuppression and coagulopathy. Progressive organ dissemination of varicella was present in each patient, with new skin lesions in 2, despite three daily infusions of adenine arabinoside (Ara-A). Ara-A was discontinued and IV acyclovir begun at the dose of 500 mg/M² every 8 hours. Clinical improvement beginning within 24 hours of initiation of acyclovir with subsequent complete recovery following 7-10 days of drug occurred in 3 of 4 patients. The remaining patient, who manifested the most severe CNS, hepatic, and pulmonary dysfunction, ceased developing new skin lesions after acyclovir was begun but showed continued CNS and pulmonary deterioration with DIC, and died after three days. We observed no toxicity except for cutaneous bullae in one patient. This experience suggests that acyclovir may play a role in the treatment of disseminated primary varicella in immunocompromised hosts. Further controlled therapeutic trials with this agent are indicated.

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