Varicella zoster virus infection associated with high-dose chemotherapy and autologous stem-cell rescue

Abstract

Summary:A retrospective evaluation of 215 consecutive recipients of high-dose chemotherapy (HDC) and autologous stem cell rescue (ASCR) was conducted to ascertain the incidence, temporal course, and outcome of varicella zoster virus (VZV) infection. Herpes zoster was identified in 40 individuals at a median of 69 days following ASCR. Six of these cases occurred at a median of 33 days prior to ASCR but following the initiation of high doses of stem cell mobilization chemotherapy. Twenty-five percent of patients demonstrated cutaneous or systemic dissemination and 32.5% required medical intervention for post-herpetic neuralgia. All except two individuals received antiviral chemotherapy. One patient with active VZV infection died of multiorgan failure 39 days after ASCR. Multivariate analysis of risk factors disclosed the significance of prophylactic acyclovir use in Herpes simplex virus seropositive individuals in reducing the risk of VZV infection. Moreover, the use of busulfan, thiotepa and carboplatin as the conditioning chemotherapy regimen was associated with an increased risk of subsequent VZV infection. The incidence of VZV reactivation after HDC and ASCR is similar to that observed following bone marrow transplantation but has an earlier onset. This may be related to an earlier induction of immunosuppression by stem cell mobilization chemotherapy administered prior to ASCR. We demonstrated a marked reduction in the proliferative and synthetic capacities of peripheral blood mononuclear cells obtained prior to and following stem cell mobilizing chemotherapy. Moreover, greater than 80% of VZV infections occurred within 6 months following ASCR and late cases were seldom observed compared to allogeneic and autologous bone marrow transplantation. The role of antiviral chemoprophylaxis during the period of maximum immunocompromise needs to be studied further in the HDC-ASCR setting.

Inappropriate antidiuretic hormone secretion, abdominal pain and disseminated varicella-zoster virus infection: an unusual triad in a patient 6 months post mini-allogeneic peripheral stem cell transplant for chronic myeloid leukemia

“…There were 10 cases of chickenpox, 43 of typical herpes zoster infection and seven disseminated zoster infections. 8 Similar results were published recently by Bilgrami et al 9 Moreover, in a large review of 1394 patients who received allogeneic or syngeneic bone marrow transplantation, Locksley et al 10 found allogeneic transplantation, GVHD and treatment with antithymocyte globulin-independent risk factors for VZV infection. In their cohort 80% of infections occurred within the first 9 month after transplant.…”

Herpes zoster infection in the post-hematopoietic stem cell transplant pediatric population may be preceded by transaminitis: an institutional experience

“…Patients who underwent an allogeneic HSCT had a significantly higher risk of HZ infection than patients who received an autologous HSCT, presumably due to the greater pharmacologic and allogeneic-mediated immune suppression. 12,26,27 Among allogeneic HSCT recipients, conditioning with TBI approached significance as a risk factor when compared to conditioning with chemotherapy alone. 4,28 However, patients who had underlying immunodeficiency or chemotherapy prior to HSCT did not demonstrate a greater risk of HZ infection compared with those presumed less compromised prior to HSCT.…”

“…antiviral therapy, and, despite treatment, had an incidence of complications that parallels rates described in several adult studies. 1,13,26 Of 64 patients, 58 (91%) of the cohort with HZ reactivation were hospitalized to receive i.v. acyclovir.…”

Varicella zoster virus reactivation after autologous SCT is a frequent event and associated with favorable outcome in myeloma patients

“…HZ is common after allogeneic or autologous BM or peripheral blood hematopoietic SCT. [4][5][6][7][8][9][10][11][12][13][14][15][16] The incidence of HZ at 1 year following autologous SCT (ASCT) varies from 8 to 30%. 3,11,[14][15][16] However, little is known about the incidence of HZ specifically in myeloma patients undergoing ASCT.…”