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RecruitingNCT05198570Updated Jun 4, 2025

Pharmacokinetics of Intravenous Acyclovir in Oncologic Paediatric Patients

An observational study in Herpesviridae Infections, Herpes Simplex 1 and Varicella Zoster Virus Infection, sponsored by University of Pisa. Recruiting at 1 site in Italy. Open to participants aged 6 Months to 18 Years. Per ClinicalTrials.gov, last updated 2025-06-04.

Sponsored by University of Pisa · Observational

Study type
Observational
Model
Case-only
Time perspective
Retrospective
Enrollment
200
Ages
6 Months to 18 Years
Sex
All
01

Study summary

  • Herpesvirus infections may be severe in immunocompromised patients, with a high risk of complications and mortality.
  • Recipients of hematopoietic stem cell transplant (HSCT) or patients receiving high-intensity chemotherapy for hematological malignancies are the most vulnerable individuals.
  • Although the worldwide prevalence of herpes simplex virus 1 (HSV-1) and varicella-zoster virus (VZV), antiviral prophylaxis in seropositive HSCT recipients has significantly reduced the rate of infection.
  • Acyclovir (ACV) is the first-choice drug for the prophylaxis or the therapy of that kind of infection.
  • Since the beginning, ACV has demonstrated to be characterized by a large interpatient variability, especially in children.
  • Therefore, therapeutic drug monitoring and pharmacokinetic studies may help in optimizing drug in children with malignancies.
Read the detailed description

Herpesvirus infections may lead to severe disease with a high risk of complications and mortality in hematopoietic stem cell transplant (HSCT) recipients, or in patients receiving high-intensity chemotherapy for hematological malignancies. That risk is mainly associated with the worldwide prevalence of herpes simplex virus 1 (HSV-1) that increases consistently with age. In particular, the majority of adult leukemia patients are HSV seropositive, while allogeneic HSCT recipients had post-transplant HSV reactivation. It is worth noting that in the first post-transplant year, symptomatic varicella-zoster virus (VZV) reactivation has a rate of 13% - 55% in adult recipients. Similar percentages of children receiving HSCT had VZV reactivation, being also possible a disseminated infection in 10% of children. However, thanks to antiviral prophylaxis in seropositive HSCT recipients, the rate of infection has significantly dropped.

Among the drugs most used for treatment and prophylaxis of HSV/VZV infections among children who are HSCT recipients or undergo a high-intensity chemotherapy, acyclovir represents the drug of choice. Although its role in preventing and treating herpes virus infections, the pharmacokinetics of acyclovir is highly variable, especially in patients in intensive care units, in those who have organ dysfunction, or in children. In particular, information about the optimal use of acyclovir in children with malignancies is limited.

02

Conditions studied

  • Herpesviridae Infections
  • Herpes Simplex 1
  • Varicella Zoster Virus Infection
  • Transplantation Infection
  • Oncology

Keywords

  • Hematopoietic stem cell transplantation
  • Herpes virus infections
  • Aciclovir
  • Children
  • Pharmacokinetics
03

Who can participate

Ages eligible
6 Months to 18 Years
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Non-probability sample

Study population

Patients aged 0-18 years, affected by hematological malignancies, undergoing ACV prophylaxis or treatment for HSV-VZV infection routinely during allogeneic HSCT or ACV treatment during high-intensity chemotherapy, for who a therapeutic drug monitoring (TDM) protocol is available. Patients receive ACV as a standard 1-h intravenous infusion or through the oral administration of valaciclovir

Inclusion criteria

  • Patients with Hematological malignancies
  • HSCT recipients who require ACV prophylaxis or treatment for HSV-VZV infection or
  • Children undergoing high-intensity antineoplastic chemotherapy who need ACV treatment.
  • Intravenous or oral ACV dosing
  • Active/available a therapeutic drug monitoring (TDM) protocol for ACV
  • Informed consent signed by patient's parents

Exclusion criteria

Exclusion Criteria:

  • lack of signed informed consent
  • lack of TDM for ACV
  • unavailable patient's demographic characteristics
04

Study design

Observational model
Case-only
Time perspective
Retrospective
Enrollment
200 participants (estimated)
Patient registry
No

Groups and cohorts

  • Intravenous Aciclovir

    Patients receiving intravenous aciclovir for prophylaxis or treatment of herpes virus infections

    Other: Pharmacokinetic analysis

  • Oral Aciclovir

    Patients receiving oral aciclovir/valaciclovir for prophylaxis or treatment of herpes virus infections

    Other: Pharmacokinetic analysis

Interventions

  • OtherPharmacokinetic analysis

    Population pharmacokinetic analysis of plasma concentrations of aciclovir obtained during routine therapeutic drug monitoring

05

What researchers measure

Primary outcomes

  1. Percentage of patients who achieve an acyclovir minimum plasma concentration of 0.5 mg/L at steady state

    Percentage of patients who achieve an acyclovir minimum plasma concentration at steady state ≥0.5 mg/L, considered as an effective plasma concentration

    Time frame: Six months since the beginning of acyclovir administration

06

Study locations

1 of 1 sites recruiting
  • IRCCS Burlo Garofolo, Bone Marrow Transplant Unit, Institute for Maternal and Child Health
    Trieste, TS 34137, Italy
    Recruiting
07

References and documents

Publications

  • Maximova N, Nistico D, Luci G, Simeone R, Piscianz E, Segat L, Barbi E, Di Paolo A. Population Pharmacokinetics of Intravenous Acyclovir in Oncologic Pediatric Patients. Front Pharmacol. 2022 Apr 14;13:865871. doi: 10.3389/fphar.2022.865871. eCollection 2022. PubMed 35496277 ↗

Individual participant data

Plan to share: No — Individual partecipant data will not be disclosed as per protocol and Ethics Committee requests. Protocol will be shared upon request, as well as the overall findings of the study

08

Registry details

Key details

Study ID
NCT05198570
Lead sponsor
University of Pisa
Collaborators
IRCCS Burlo Garofolo
Responsible party
Antonello Di Paolo, M.D., Ph.D. (Associate Professor of Pharmacology, University of Pisa) — Principal investigator
First posted
Jan 20, 2022
Start date
Sep 15, 2021
Primary completion
Dec 31, 2025 (estimated)
Completion
Mar 31, 2026 (estimated)
Last update
Jun 4, 2025

Study contacts

Natalia Maximova, MD
Contact
natalia-maximova@burlo.trieste.it
040 378 5111 ext. 565
Natalia Maximova, MD
principal investigator · IRCCS Burlo Garofolo

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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