Herpes zoster after autologous hematopoietic stem cell transplantation

Abstract

BackgroundThe autologous hematopoietic stem cell transplantation procedure involves immunosuppression of the patient. Thus, the patient has an elevated risk for several diseases, such as infections with the varicella-zoster virus. Prevention protocols have been proposed based on the use of acyclovir from the first day of conditioning, and maintaining this drug for 30–100 days after the procedure or for as much as one year. The objective of this work was to evaluate the incidence of herpes zoster after autologous transplantations related to the early suspension of acyclovir.MethodsA retrospective study was carried out based on the collection of data from 231 medical records of transplant patients in the Bone Marrow Transplant Unit of the teaching hospital of the Universidade Federal de Juiz de Fora in the period between 2004 and 2014.ResultsFourteen (6.1%) patients had herpes zoster in the post-transplant period on average within six months of the procedure. Patients with multiple myeloma (64.3%) were the most affected. There was a statistically significant difference in the age of the patients, with older individuals having a greater chance of developing the infection (p-value = 0.002). There were no significant differences for the other variables analyzed.ConclusionThe early suspension of acyclovir can be safe in patients who receive autologous hematopoietic stem cell transplants. However some groups may benefit from extended prophylaxis with acyclovir, particularly older patients and patients with multiple myeloma.

The beneficial effects of varicella zoster virus

“…Prophylaxis against reactivation of VZV infections: Reactivation of VZV infections may occur in patients with various HMs and in recipients of autologous as well as allogeneic HSCT [77,[174][175][176][177]. Reactivation of VZV infections in these severely immune compromised individuals may be associated with complications such as disseminated infections, signi icant morbidity, and mortality rates that may reach 34% [77,[174][175][176][177][178][179].…”

“…Prophylaxis against reactivation of VZV infections: Reactivation of VZV infections may occur in patients with various HMs and in recipients of autologous as well as allogeneic HSCT [77,[174][175][176][177]. Reactivation of VZV infections in these severely immune compromised individuals may be associated with complications such as disseminated infections, signi icant morbidity, and mortality rates that may reach 34% [77,[174][175][176][177][178][179]. Therefore, prevention of reactivation of VZV infections in this group of patients; particularly those with MM, low lymphocytic count, and those on long-term corticosteroid therapy; is needed to prevent complications of VZV infections [77,[174][175][176][177]179,181].…”

“…Reactivation of VZV infections in these severely immune compromised individuals may be associated with complications such as disseminated infections, signi icant morbidity, and mortality rates that may reach 34% [77,[174][175][176][177][178][179]. Therefore, prevention of reactivation of VZV infections in this group of patients; particularly those with MM, low lymphocytic count, and those on long-term corticosteroid therapy; is needed to prevent complications of VZV infections [77,[174][175][176][177]179,181]. Acyclovir prophylaxis is recommended in patients with: (1) HMs receiving intensive chemotherapy or novel agents, and (2) recipients of autologous and allogeneic HSCT [174-177, 179,181,182].…”

“…Acyclovir prophylaxis is recommended in patients with: (1) HMs receiving intensive chemotherapy or novel agents, and (2) recipients of autologous and allogeneic HSCT [174-177, 179,181,182]. Initially, there was a trend to give acyclovir prophylaxis for up to 6 or 12 months in recipients of autologous and allogeneic HSCT respectively [174,178,180,182]. Nowadays, the recent literature is in favor of giving antiviral prophylaxis for longer than one year in recipients of HSCT [174,175,177,178,180,182].…”

“…Initially, there was a trend to give acyclovir prophylaxis for up to 6 or 12 months in recipients of autologous and allogeneic HSCT respectively [174,178,180,182]. Nowadays, the recent literature is in favor of giving antiviral prophylaxis for longer than one year in recipients of HSCT [174,175,177,178,180,182]. Several retrospective studies have shown that extended prophylaxis with acyclovir has been shown to be safe and effective [175,180].…”