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Observational Study
. 2017 Mar;23(3):505-511.
doi: 10.1016/j.bbmt.2016.12.620. Epub 2016 Dec 28.

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

Farah Sahoo  1 , Joshua A Hill  2 , Hu Xie  3 , Wendy Leisenring  3 , Jessica Yi  4 , Sonia Goyal  4 , Louise E Kimball  4 , Ingi Lee  5 , Sachiko Seo  4 , Chris Davis  3 , Stephen A Pergam  6 , Mary E Flowers  7 , Kai-Li Liaw  5 , Leona Holmberg  8 , Michael Boeckh  9
Affiliations
Observational Study

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

Farah Sahoo et al. Biol Blood Marrow Transplant. 2017 Mar.

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.

Keywords: Autologous; Herpes zoster; Transplant; VZV; Varicella zoster virus.

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Figures

Figure 1
Figure 1. Cumulative incidence curves of time to HZ episode
Panel A demonstrates the cumulative incidence of first HZ episodes in the entire cohort over time. 194 patients had an initial HZ episode within 5 years after autologous HCT with a cumulative incidence of 21% (95% CI, 18%-24%). Panel B demonstrates the cumulative incidence of recurrent HZ episodes over time. 31 patients had a recurrent episode of HZ after autologous HCT.
See this image and copyright information in PMC

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