Herpes zoster incidence and cost in patients receiving autologous hematopoietic stem-cell transplant

Mao, Jianbin; McPheeters, Jeffrey; Zhang, Dongmu; Acosta, Camilo J.; Finelli, L.

doi:10.1080/03007995.2017.1384374

Cited by 5 publications

(8 citation statements)

References 34 publications

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“… 3 Another study of a US health care plan reported that patients with hematologic malignancies and those with solid tumors had an age- and sex-standardized rate of HZ that was 4.8 times higher and 1.9 times higher, respectively, than the rate in the general population. 5 A study of patients who had received an autologous hematopoietic stem cell transplant (HSCT) reported an overall HZ incidence of 62 per 1,000 persons per year (31 per 1,000 in patients who received antiviral prophylaxis and 152 per 1,000 in those who did not), 27 while another study in solid organ transplant recipients reported an incidence of 22 per 1,000 persons per year. 28 Patients living with HIV are also at greater risk of HZ, even in the age of highly active antiretroviral treatment, with rates approximately three times higher than the general population.…”

Section: Studies In Immunocompromised Populationsmentioning

confidence: 99%

Safety and reactogenicity of the adjuvanted recombinant zoster vaccine: experience from clinical trials and post-marketing surveillance

Fiore

Mee

Maldonado³

et al. 2021

Therapeutic Advances in Vaccines and Immunotherapy

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An adjuvanted recombinant zoster vaccine (RZV) is licensed for the prevention of herpes zoster. This paper reviews its safety and reactogenicity. A pooled analysis of two pivotal randomized Phase-3 trials (NCT01165177, NCT01165229) in adults ⩾50 years found that more solicited adverse events (AEs) were reported with RZV than placebo. Injection site pain was the most common solicited AE (RZV: 78.0% participants; placebo: 10.9%). Grade-3 pain occurred in 6.4% of RZV and 0.3% of placebo recipients. Myalgia, fatigue, and headache were the most commonly reported general solicited AEs (RZV: 44.7%, 44.5%, and 37.7%, respectively; placebo: 11.7%, 16.5%, and 15.5%, respectively). Most symptoms were mild to moderate in intensity with a median duration of 2–3 days. The intensity of reactogenicity symptoms did not differ substantially after the first and second vaccine doses. The pooled analysis of the pivotal Phase-3 trials did not identify any clinically relevant differences in the overall incidence of serious adverse events (SAEs), fatal AEs or potential immune-mediated diseases (pIMDs) between RZV and placebo. Reactogenicity in five studies of immunocompromised patients ⩾18 years (autologous stem cell transplant, human immunodeficiency virus, solid tumors, hematological malignancies, and renal transplant; NCT01610414, NCT01165203, NCT01798056, NCT01767467, and NCT02058589) was consistent with that observed in the pivotal Phase-3 trials. There were no clinically relevant differences between RZV and placebo in the immunocompromised populations with regard to overall incidence of SAEs, fatal AEs, pIMDs, or AEs related to patients’ underlying condition. Post-marketing surveillance found that the most commonly reported AEs were consistent with the reactogenicity profile of the vaccine in clinical trials. Overall, the clinical safety data for RZV are reassuring. [Formula: see text]

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Section: Studies In Immunocompromised Populationsmentioning

confidence: 99%

Safety and reactogenicity of the adjuvanted recombinant zoster vaccine: experience from clinical trials and post-marketing surveillance

Fiore

Mee

Maldonado³

et al. 2021

Therapeutic Advances in Vaccines and Immunotherapy

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show abstract

“…The reduction of HZ risk after ASCT is consistent with results from other publications. [9][10][11][12][13][14][15] The meta-analysis of six studies with 3420 patients published by Seo et al in 2017 10 demonstrates "that antiviral prophylaxis can reduce HZ development in recipients of both types of hematopoietic stem cell transplantation (autologous and allogeneic HSCT). Moreover, long-term prophylaxis given for at least one year may be recommended to get better preventive effects, irrespective of HSCT type".…”

Section: Prognostic Factorsmentioning

confidence: 99%

“…[2][3][4][5][6][7][8] A prophylaxis with acyclovir is described as effective in some studies. [9][10][11][12][13][14][15] It is currently an open question, which acyclovir dose is beneficial. Another possibility is the vaccination of patients with a new vaccine which appears to be effective for a proportion of about two thirds of ASCT patients.…”

Section: Introductionmentioning

confidence: 99%

Herpes zoster prophylaxis with low‐dose acyclovir in patients with malignant lymphoma and multiple myeloma treated with autologous stem cell transplantation

Abbasov

Metzner

Müller

et al. 2022

European J of Haematology

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Background Herpes zoster (HZ) is a frequent complication after autologous stem cell transplantation (ASCT). The option of zoster prophylaxis with an antiviral drug is described in the literature, but there is no consensus on the drug and the dosage. Patients and Methods We analyzed the records of 310 patients treated with ASCT who were controlled regularly regarding HZ inter alia for at least 24 months following ASCT. Since 01/2015 patients received prophylactic low‐dose acyclovir (400 mg per day) during the first 12 months following discharge after ASCT (n = 107). Results Twenty percent of patients without this kind of prophylaxis and 2.8% of patients with prophylaxis developed HZ (p < .001). No patient with this prophylaxis developed HZ in the first year after ASCT, 2.8% of patients in the second year after ASCT. A prognostic factor was the kind of diagnosis: 30% of lymphoma patients and 14% of myeloma patients developed HZ in the first 24 months after ASCT without prophylaxis, but only 6.3% and 0% of patients with prophylaxis, respectively. Neither an increase of HZ cases following prophylaxis nor acyclovir refractory HZ cases were observed. Conclusions Zoster prophylaxis with low‐dose acyclovir over 12 months after ASCT is effective and well tolerated.

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“…In another study including 444 adult kidney transplants, administering anti-CMV prophylaxis (ganciclovir/valganciclovir) for 3–6 months after transplantation reduced the risk of HZ and no patients developed HZ during CMV antiviral prophylaxis ( 20 ). Although antiviral prophylaxis is effective for preventing HZ, the risk of VZV reactivation is still much higher in transplant patients than the general population ( 20 , 95 , 96 ). It is also difficult to completely prevent the development of HZ after the discontinuation of prophylaxis.…”

Section: Prevention/prophylaxismentioning

confidence: 99%

Herpes Zoster and Immunogenicity and Safety of Zoster Vaccines in Transplant Patients: A Narrative Review of the Literature

et al. 2018

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This narrative review focuses on the herpes zoster (HZ) and its prevention in transplant patients. Varicella zoster virus (VZV) is highly contagious and distributed worldwide in humans. Primary VZV infection usually causes varicella and then establishes a lifelong latency in dorsal root ganglia. Reactivation of VZV leads to HZ and related complications such as postherpetic neuralgia. Age and decreased immunity against VZV are important risk factors for developing HZ. Transplant patients are at increased risk for developing HZ and related complications due to their immunocompromised status and the need for lifetime immunosuppression. Diagnosis of HZ in transplant patients is often clinically difficult, and VZV-specific antibodies should be determined by serologic testing to document prior exposure to VZV during their pre-transplant evaluation process. Although antiviral agents are available, vaccination should be recommended for preventing HZ in transplant patients considering their complicated condition and weak organ function. Currently, there are two licensed HZ vaccines, of which one is a live-attenuated vaccine and the other is a HZ subunit vaccine. Both vaccines have shown promising safety and efficacy in transplants patients and especially the subunit vaccine could be administered post-transplant since this vaccine does not contain any live virus. Larger studies are needed about safety and immunogenicity of HZ vaccines in transplant populations, and extra efforts are needed to increase vaccine usage according to guidelines.

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Herpes zoster incidence and cost in patients receiving autologous hematopoietic stem-cell transplant

Abstract: HZ incidence was high, despite AP use. Mean annual healthcare costs were higher for patients with HZ, but the difference was not statistically significant. An effective vaccine against HZ could be useful in decreasing both incidence of and cost for HZ in this population.

Cited by 5 publications

References 34 publications

Safety and reactogenicity of the adjuvanted recombinant zoster vaccine: experience from clinical trials and post-marketing surveillance

Safety and reactogenicity of the adjuvanted recombinant zoster vaccine: experience from clinical trials and post-marketing surveillance

Herpes zoster prophylaxis with low‐dose acyclovir in patients with malignant lymphoma and multiple myeloma treated with autologous stem cell transplantation

Herpes Zoster and Immunogenicity and Safety of Zoster Vaccines in Transplant Patients: A Narrative Review of the Literature

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