Severe Herpes Zoster Requiring Intravenous Antiviral Treatment in Allogeneic Hematopoietic Cell Transplantation Recipients on Standard Acyclovir Prophylaxis.

Authors:
Emily Baumrin
Emily Baumrin
Brigham and Women's Hospital
United States
Matthew P Cheng
Matthew P Cheng
McGill University
Canada
Sanjat Kanjilal
Sanjat Kanjilal
The George Washington School of Public Health and Health Services
United States
Vincent T Ho
Vincent T Ho
Dana-Farber Cancer Institute
United States
Nicolas C Issa
Nicolas C Issa
Brigham and Women's Hospital
United States
Lindsey R Baden
Lindsey R Baden
Brigham and Women's Hospital
United States

Biol Blood Marrow Transplant 2019 Apr 17. Epub 2019 Apr 17.

Department of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.

Allogeneic hematopoietic cell transplantation (HCT) recipients are at increased risk for varicella zoster virus (VZV) reactivation and associated complications. The incidence, timing, and risk factors for severe herpes zoster (HZ) are not well described in the era of acyclovir (ACV) prophylaxis. We performed a retrospective cohort study of all patients who underwent first allogeneic HCT between October 2006 and December 2015 at our institution. Patients were followed until December 2017 for the development of severe HZ, defined as necessitating administration of i.v. antiviral medication. Out of 2163 patients who underwent allogeneic HCT, 22 (1.0%) developed severe HZ at a rate of 1 per 228 person-years, including dermatomal/multidermatomal disease (n = 5), disseminated skin disease (n = 5), HZ ophthalmicus (n = 4), meningitis/encephalitis (n = 4), pneumonia (n = 2), viremia (n = 1), and erythema multiforme (n = 1). Severe HZ infection occurred in a bimodal distribution during the early peri-HCT period and at 12 to 24 months post-HCT (median, 12.7 months). Twelve patients (54.5%) were compliant with ACV prophylaxis at the time of HZ diagnosis. Eleven patients (50%) died during the study period, only 2 of whom (9.1%) with active VZV infection. Mortality was higher in patients on immunosuppressive therapy (62.5% versus 16.7%; P = .045) and with concurrent graft-versus-host disease (75.0% versus 35.7%; P= .044). These data suggest that severe HZ remains an important consideration despite ACV prophylaxis.

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http://dx.doi.org/10.1016/j.bbmt.2019.04.015DOI Listing
April 2019
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