Abstract |
The epidemiology of herpes zoster (HZ) in contemporary autologous hematopoietic cell transplant (HCT) recipients, and the impact of acyclovir (ACV)/ valacyclovir (VACV) prophylaxis, is not well described. In this observational study from 2002 to 2010, we retrospectively identified 1000 varicella zoster virus (VZV)-seropositive autologous HCT recipients with up to 5 years of follow-up. The incidence of HZ and use of ACV/VACV prophylaxis were determined through review of medical records and mailed questionnaires. Risk factors for HZ were determined by multivariable Cox regression. Over a period of 5 years after autologous HCT, 194 patients developed at least 1 HZ episode, with a cumulative incidence of 21%; 159 of 194 (82%) were not on prophylaxis at the time of HZ. A second episode of HZ occurred in 31 of 194 (16%) patients. Patients taking ACV/VACV had reduced risk for HZ (adjusted hazard ratio [aHR], .59; 95% confidence interval [CI], .37 to .91), whereas those older than the median age (≥55.5 years) had increased risk (aHR, 1.42; 95% CI, 1.05 to 1.9). Disseminated VZV was reported in 8% and postherpetic neuralgia in 13% of patients. We demonstrate a high burden of HZ late after autologous HCT, despite long-term antiviral prophylaxis. Improved prevention strategies are needed to provide sustained protection against HZ after autologous HCT.
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Authors | Farah Sahoo, Joshua A Hill, Hu Xie, Wendy Leisenring, Jessica Yi, Sonia Goyal, Louise E Kimball, Ingi Lee, Sachiko Seo, Chris Davis, Stephen A Pergam, Mary E Flowers, Kai-Li Liaw, Leona Holmberg, Michael Boeckh |
Journal | Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
(Biol Blood Marrow Transplant)
Vol. 23
Issue 3
Pg. 505-511
(Mar 2017)
ISSN: 1523-6536 [Electronic] United States |
PMID | 28039754
(Publication Type: Journal Article, Observational Study)
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Copyright | Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Valine
- Valacyclovir
- Acyclovir
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Topics |
- Acyclovir
(analogs & derivatives, therapeutic use)
- Female
- Hematopoietic Stem Cell Transplantation
(adverse effects)
- Herpes Zoster
(drug therapy, epidemiology, etiology, prevention & control)
- Humans
- Incidence
- Male
- Middle Aged
- Neuralgia, Postherpetic
- Premedication
- Retrospective Studies
- Risk Factors
- Time Factors
- Transplantation, Autologous
- Valacyclovir
- Valine
(analogs & derivatives, therapeutic use)
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