A 70-year-old patient with multiple myeloma is being started on bortezomib-based therapy. Which prophylactic measure is specifically required with bortezomib that is not routinely needed with lenalidomide-based regimens?
- A Acyclovir prophylaxis against herpes zoster reactivation ✓
- B Aspirin prophylaxis for VTE
- C Fluconazole prophylaxis against invasive fungal infections
- D Levofloxacin prophylaxis against bacterial infections
Correct answer: A. Acyclovir prophylaxis against herpes zoster reactivation
Explanation
Bortezomib (a proteasome inhibitor) substantially impairs cellular immunity and T-cell function, significantly increasing the risk of varicella-zoster virus (VZV) reactivation — herpes zoster occurs in up to 13% of patients without prophylaxis. Antiviral prophylaxis with acyclovir (400 mg twice daily) or valacyclovir is mandatory throughout bortezomib therapy. VTE prophylaxis (aspirin or LMWH) is primarily indicated with IMiDs (lenalidomide, thalidomide). Levofloxacin prophylaxis may be used in newly diagnosed myeloma based on the TEAMM trial.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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