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Herpes Zoster in Autologous Hematopoietic Cell Transplant Recipients in the Era of Acyclovir or Valacyclovir Prophylaxis and Novel Treatment and Maintenance Therapies.

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.
AuthorsFarah 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
JournalBiology 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
PMID28039754 (Publication Type: Journal Article, Observational Study)
CopyrightCopyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
Chemical References
  • Valine
  • Valacyclovir
  • Acyclovir
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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