Abstract
We examined the incidence of herpes varicella-zoster virus (VZV) infection in 151 patients undergoing allogeneic BMT between August 1990 and September 1997 and who survived at least 3 months. Median follow-up was 17 (range 3.3–80.7) months. Herpes simplex virus antibody positive (HSV+) patients received aciclovir 1200 mg p.o. daily or 750 mg i.v. daily, in divided doses from day 0 to engraftment. Ganciclovir (5 mg/kg i.v. three times per week) was given in CMV+ patients (or if the donor was CMV+) from engraftment to day 84. Ganciclovir was continued or recommenced if a dose of greater than 20 mg of prednisone was used for the treatment of GVHD otherwise aciclovir was recommenced. In HSV+ patients not receiving ganciclovir, aciclovir 600 mg p.o. daily in divided doses was given until at least 6 months after BMT. Thirty-two patients developed VZV infection from 4.1 to 28 months after transplant. The estimated cumulative incidence of VZV was 13% (95% confidence interval 6–19%) at 12 months, 32% (22–42%) at 24 months and 38% (27–50%) at 28 months, with no further cases beyond that time. No patient developed VZV whilst receiving aciclovir or ganciclovir (P < 0.0001). However, there was a rapid onset of VZV following cessation of antiviral therapy (33% (20–46%) at 1 year post cessation). The presence of GVHD and the prior duration of antiviral prophylaxis were significant and independent risk factors for the development of VZV. Age, underlying disease, conditioning therapy or donor type were not. we conclude that 3–6 months of low-dose aciclovir and ganciclovir are effective at delaying the onset of VZV after allogeneic BMT, but may not affect the overall incidence of infection. Prolonged prophylaxis may be warranted in patients at high risk of infection, for example those patients with GVHD. Bone Marrow Transplantation (2000) 25, 657–664.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Han CS, Miller W, Haake R, Weisdorf D . Varicella zoster virus after bone marrow transplantation: incidence, risk factors and complications Bone Marrow Transplant 1994 13: 277–283
Locksley RM, Flournoy N, Sullivan KM, Meyers JD . Infection with varicella-zoster virus after marrow transplantation J Infect Dis 1985 152: 1172–1181
Atkinson K, Meyers JD, Storb R et al. Varicella-zoster virus infection after marrow transplantation for aplastic anemia or leukemia Transplantation 1980 29: 47–50
Tzeng CH, Liu JH, Fan S et al. Varicella zoster virus infection after allogeneic or autologous hemopoietic stem cell transplantation J Formos Med Assoc 1995 94: 313–317
Koc Y, Miller K, Schenkein D et al. Varicella zoster virus (VZV) infections following allogeneic bone marrow transplantation (BMT): frequency, risk factors, clinical outcome and antiviral prophylaxis Blood 1997 90: (Suppl. 1) 543a
Schuchter LM, Wingard JR, Piantadosi S et al. Herpes zoster infection after autologous bone marrow transplantation Blood 1989 74: 1424–1427
Saral R, Burns WH, Laskin OL et al. Acyclovir prophylaxis of herpes-simplex virus infections New Engl J Med 1981 305: 63–67
Gluckman E, Lotsberg J, Devergie A et al. Prophylaxis of herpes infections after bone marrow transplantation by oral acyclovir Lancet 1983 2: 706–708
Selby PJ, Powles RL, Easton D et al. The prophylactic role of intravenous and long-term oral acyclovir after allogeneic bone marrow transplantation Br J Cancer 1989 59: 434–438
Ljungman P, Lonnqvist B, Gahrton G et al. Clinical and subclinical reactivations of varicella-zoster virus in immunocompromised patients J Infect Dis 1986 153: 840–847
Whitley R, Gnann J . Acyclovir: a decade later New Engl J Med 1992 327: 782–789
Abraham R, Szer J, Bardy P, Grigg A . Early cyclosporine taper in high-risk sibling allogeneic bone marrow transplants Bone Marrow Transplant 1997 20: 773–777
Atkinson K, Arthur C, Bradstock K et al. Prophylactic ganciclovir is more effective in HLA-identical family member recipients than in more heavily immune-suppressed HLA-identical unrelated marrow transplant recipients Bone Marrow Transplant 1995 16: 401–406
Koc Y, Miller K, Schenkein D et al. Ganciclovir administration for cytomegalovirus infection prophylaxis delays onset of varicella zoster virus reactivation in allogeneic bone marrow transplant recipients Blood 1997 92: (Suppl. 1) 280a
Wilson A, Sharp M, Koropchak CM et al. Subclinical varicella-zoster virus viremia, herpes zoster, and T lymphocyte immunity to varicella-zoster viral antigens after bone marrow transplantation J Infect Dis 1992 165: 119–126
Saxon A, McIntyre RE, Stevens RH, Gale RP . Lymphocyte dysfunction in chronic graft-versus-host disease Blood 1981 58: 746–751
Witherspoon RP, Lum LG, Storb R . Immunologic reconstitution after human marrow grafting Semin Hematol 1984 21: 2–10
Santos GW, Hess AD, Vogelsang GB . Graft-versus-host reactions and disease Immunol Rev 1985 88: 169–192
Meyers JD, Flournoy N, Thomas ED . Cell-mediated immunity to varicella-zoster virus after allogeneic marrow transplant J Infect Dis 1980 141: 479–487
Lekstrom-Himes J, Straus S . Varicella zoster virus infections in the normal and immunocompromised host. In: Sacks SL, Straus SE, Whitley RJ, Griffiths PD (eds) Clinical Management of Herpes Viruses IOS Press: Amsterdam 1995 pp 175–192
Ellis MN, Martin JL, Lobe DC . Induction of acyclovir-resistant mutants of herpes simplex virus type 1 in athymic nude mice J Antimicrob Chemother 1986 18: (Suppl. B) 95–101
Matthews T, Boehme R . Antiviral activity and mechanism of action of ganciclovir Rev Infect Dis 1988 10: (Suppl. 3) S490–S494
Soike KF, Eppstein DA, Gloff CA . Effect of 9-(1,3-dihydroxy-2-propoxymethyl)guanine and recombinant human beta interferon alone and in combination on simian varicella virus infection in monkeys J Infect Dis 1987 156: 607–614
Acknowledgements
Partial funding for the analysis was provided by Glaxo Wellcome Australia.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Steer, C., Szer, J., Sasadeusz, J. et al. Varicella-zoster infection after allogeneic bone marrow transplantation: incidence, risk factors and prevention with low-dose aciclovir and ganciclovir. Bone Marrow Transplant 25, 657–664 (2000). https://doi.org/10.1038/sj.bmt.1702190
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1702190
Keywords
This article is cited by
-
Neurologic complications after allogeneic hematopoietic stem cell transplantation: risk factors and impact
Bone Marrow Transplantation (2018)
-
Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific
BMC Infectious Diseases (2017)