scholarly journals Varicella Zoster Virus Reactivation in Adult Survivors of Hematopoietic Cell Transplantation: How Do We Best Protect Our Patients?

2018 ◽  
Vol 24 (9) ◽  
pp. 1783-1787 ◽  
Author(s):  
Catherine J. Lee ◽  
Bipin N. Savani ◽  
Per Ljungman
Keyword(s):  
Varicella Zoster Virus ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Adult Survivors ◽  
Hematopoietic Cell ◽  
Virus Reactivation ◽  
Varicella Zoster

scholarly journals Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation—a randomized double-blind placebo-controlled study

Blood ◽  
2006 ◽  
Vol 107 (5) ◽  
pp. 1800-1805 ◽  
Author(s):  
Michael Boeckh ◽  
Hyung W. Kim ◽  
Mary E. D. Flowers ◽  
Joel D. Meyers ◽  
Raleigh A. Bowden
Keyword(s):  
Varicella Zoster Virus ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Hematopoietic Cell Transplant ◽  
Double Blind ◽  
Varicella Zoster ◽  
Cmv Disease

Varicella-zoster virus (VZV) disease occurs in 30% of allogeneic hematopoietic cell transplant recipients who had a history of VZV infection. A safe and effective prevention strategy has not been established. In a double-blind controlled trial, 77 hematopoietic cell transplant recipients at risk for VZV reactivation were randomized to acyclovir 800 mg twice daily or placebo given from 1 to 2 months until 1 year after transplantation. VZV disease at 1 year was the primary end point; VZV disease after discontinuation of prophylaxis, VZV-specific T-cell immunity, herpes simplex virus (HSV) infection, cytomegalovirus (CMV) disease, survival, and safety were secondary end points. Acyclovir significantly reduced VZV infections at 1 year after transplantation (HR, 0.16; 95% CI, 0.035-0.74; P = .006). In the postintervention observation period, this difference was not statistically significant (2 years: HR, 0.52; 95% CI, 0.21-1.3; 5 years: HR, 0.76; 95% CI, 0.36-1.6). There was no statistically significant difference in reconstitution of VZV-specific T-helper cell responses, HSV infections, CMV disease, chronic graft-versus-host disease, and overall survival between the groups. Acyclovir was well tolerated. Post-study VZV disease predominantly occurred in patients with continued need for systemic immunosuppression. In conclusion, acyclovir effectively and safely prevents VZV disease during the first year after hematopoietic cell transplantation. Periods of prophylaxis longer than 12 months may be beneficial for those hematopoietic cell transplant recipients on continued immune suppression.

scholarly journals Reduced immunogenicity of the adjuvanted recombinant zoster vaccine after hematopoietic cell transplant: a pilot study

2020 ◽  
Vol 4 (19) ◽  
pp. 4618-4622
Author(s):  
Jose F. Camargo ◽  
Rick Y. Lin ◽  
Yoichiro Natori ◽  
Anthony D. Anderson ◽  
Maritza C. Alencar ◽  
...  
Keyword(s):  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Virus Reactivation ◽  
Cell Recovery ◽  
Zoster Vaccine ◽  
Hematopoietic Cell Transplant ◽  
Varicella Zoster ◽  
Key Points

Key Points Shingrix is poorly immunogenic following allogeneic hematopoietic cell transplantation independent of age, CD4, and B-cell recovery. In hematopoietic cell transplantation recipients with antibody response to the vaccine, varicella zoster virus reactivation risk is not null.

One-year acyclovir prophylaxis for preventing varicella-zoster virus disease after hematopoietic cell transplantation: no evidence of rebound varicella-zoster virus disease after drug discontinuation

Blood ◽  
2007 ◽  
Vol 110 (8) ◽  
pp. 3071-3077 ◽  
Author(s):  
Veronique Erard ◽  
Katherine A. Guthrie ◽  
Cara Varley ◽  
Judson Heugel ◽  
Anna Wald ◽  
...  
Keyword(s):  
Varicella Zoster Virus ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Virus Disease ◽  
Rebound Effect ◽  
Immunosuppressive Drugs ◽  
Hematopoietic Cell ◽  
Drug Discontinuation ◽  
Varicella Zoster ◽  
Acyclovir Prophylaxis

Abstract No consensus exists on whether acyclovir prophylaxis should be given for varicella-zoster virus (VZV) prophylaxis after hematopoietic cell transplantation because of the concern of “rebound” VZV disease after discontinuation of prophylaxis. To determine whether rebound VZV disease is an important clinical problem and whether prolonging prophylaxis beyond 1 year is beneficial, we examined 3 sequential cohorts receiving acyclovir from day of transplantation until engraftment for prevention of herpes simplex virus reactivation (n = 932); acyclovir or valacyclovir 1 year (n = 1117); or acyclovir/valacyclovir for at least 1 year or longer if patients remained on immunosuppressive drugs (n = 586). In multivariable statistical models, prophylaxis given for 1 year significantly reduced VZV disease (P < .001) without evidence of rebound VZV disease. Continuation of prophylaxis beyond 1 year in allogeneic recipients who remained on immunosuppressive drugs led to a further reduction in VZV disease (P = .01) but VZV disease developed in 6.1% during the second year while receiving this strategy. In conclusion, acyclovir/valacyclovir prophylaxis given for 1 year led to a persistent benefit after drug discontinuation and no evidence of a rebound effect. To effectively prevent VZV disease in long-term hematopoietic cell transplantation survivors, additional approaches such as vaccination will probably be required.

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