Varicella-zoster virus-specific cell-mediated immunity and herpes zoster development in multiple myeloma patients receiving bortezomib- or thalidomide-based chemotherapy.

Abstract

BACKGROUND:

The incidence of herpes zoster is substantial during bortezomib treatment in patients with multiple myeloma (MM).

OBJECTIVES:

This study aimed to elucidate the effect of chemotherapy with or without bortezomib in MM patients on their herpes zoster incidence and varicella zoster virus (VZV)-specific cell-mediated immunity (CMI).

STUDY DESIGN:

Peripheral blood mononuclear cells were collected at baseline and after 1 month of bortezomib-based or thalidomide-based chemotherapy and then analyzed using VZV-specific interferon-gamma (IFN-γ) enzyme-linked immunospot (ELISPOT) assay. The clinical data from these patients were analyzed in relation to the ELISPOT results.

RESULTS:

Of 58 patients analyzed, 39 patients received bortezomib and the other 19 patients, thalidomide. Among them, 5 patients developed herpes zoster during chemotherapy; all 5 were being treated with the bortezomib-based regimen and were not receiving prophylactic anti-viral agents. The median onset of herpes zoster was 32 days (range, 15-95 days) from the initiation of chemotherapy. Among patients who received bortezomib therapy, acyclovir prophylaxis significantly reduced the risk for herpes zoster (100-day cumulative incidence, 0% vs. 49.5%; p<0.001). Spot-forming cell (SFC) counts in the IFN-γ ELISPOT assay decreased from baseline after bortezomib (p=0.011) or thalidomide (p=0.096) treatment. Patients with baseline SFCs greater than 20/10(6) mononuclear cells exhibited significantly higher incidence of herpes zoster (100-day cumulative incidence, 34.8% vs. 0%; p=0.040).

CONCLUSIONS:

Bortezomib treatment significantly reduced VZV-specific CMI, and high baseline SFC counts in patients receiving this treatment without acyclovir prophylaxis were associated with a significantly increased risk for herpes zoster.

• Authors: Ji-Won Kim, Chang-Ki Min, Yeung-Chul Mun, Yong Park, Byung Soo Kim, Seung-Hyun Nam, Youngil Koh, Ji-Hyun Kwon, Pyoeng Gyun Choe, Wan Beom Park, Inho Kim
• Journal: Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology (J Clin Virol) Vol. 73 Pg. 64-69 (Dec 2015) ISSN: 1873-5967 [Electronic] Netherlands
• PMID: 26546878 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2015 Elsevier B.V. All rights reserved.

Chemical References

• Antineoplastic Agents
• IFNG protein, human
• Thalidomide
• Bortezomib
• Interferon-gamma

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents (therapeutic use)
• Bortezomib (therapeutic use)
• Female
• Herpes Zoster (immunology, prevention & control, virology)
• Herpesvirus 3, Human (immunology)
• Humans
• Interferon-gamma (metabolism)
• Male
• Middle Aged
• Multiple Myeloma (drug therapy, immunology, virology)
• Thalidomide (therapeutic use)
• Treatment Outcome