Program Schedule

436
Five Year Cumulative Incidence of Herpes Zoster (HZ) in Autologous Hematopoietic Cell Transplant (HCT) Recipients who Received Long-Term Acyclovir or Valacyclovir Prophylaxis

Session: Poster Abstract Session: Transplant Infectious Diseases
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Background: Antiviral prophylaxis with acyclovir/valacyclovir (ACV/VCV) after allogeneic HCT reduces HZ and its complications, but benefits of prophylaxis after autologous HCT are not well described. We determined the incidence of and risk factors for HZ over 5 years in a large cohort of autologous HCT recipients from an era that included ACV/VCV prophylaxis and maintenance chemotherapy for the underlying disease.

Methods: We retrospectively identified 1000 consecutive varicella zoster virus seropositive autologous HCT recipients from 2002 to 2010. Antiviral prophylaxis was prescribed with ACV 800 mg or VCV 500 mg twice daily for 1 year post-HCT. Cumulative incidence of HZ was evaluated and multivariable Cox regression models were used to evaluate adjusted hazard ratios (aHR) and associated confidence intervals (CI) for the association of ACV/VCV with HZ while adjusted for sex, type of transplant (single vs. tandem) and pre-HCT HZ.

Results: Patients were followed for a median of 39.7 months (interquartile range [IQR], 20.7-66.1 months). A total of 192 patients developed at least one HZ episode over 5 years following HCT with an overall cumulative incidence of 0.21 (95% CI, 0.18-0.24) (Figure 1) at a median of 19 months (IQR, 14.4-31.3 months). The majority of patients who developed HZ 157/192 (81.7%) were no longer taking prophylaxis at the time of HZ. A second episode of HZ occurred in 31/192 (16%) of patients at a median of 14.8 months (IQR, 7.1-24.9 months) after the first HZ episode (Figure 2). ACV/VCV had a protective effect against HZ (aHR, 0.61; 95% CI, 0.39-0.95; p=0.03). Disseminated disease occurred in 18/192 (9.4%) patients during the first HZ episode and 3/31 (9.7%) patients during the second episode of HZ after HCT.

Conclusion:   In a large population of autologous HCT recipients who were prescribed one year of ACV/VCV, over 20% of patients developed HZ during 5 years of follow-up, with the majority occurring after completing antiviral prophylaxis. Improved prevention strategies (e.g. an effective vaccine) are needed to provide long-term protection against HZ in high-risk autologous HCT recipients.

 

Farah Sahoo, MD1, Hu Xie, MSc2, Wendy Leisenring, Sc.D.1, Sonia Goyal, MD, MPH1, Jessica Yi, BS1, Louise Kimball, RN, PhD1, Ingi Lee, MD3, Joshua Hill, MD1,4, Sachiko Seo, MD1, Chris Davis1, Steven Pergam, MD, MPH4,5,6, Kai-Li Liaw, PhD3, Leana Holmberg, MD1 and Michael Boeckh, MD1,4, (1)Fred Hutchinson Cancer Research Center, Seattle, WA, (2)Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, (3)Merck Research Laboratories, North Wales, PA, (4)Department of Medicine, University of Washington, Seattle, WA, (5)Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, (6)Seattle Cancer Care Alliance, Seattle, WA

Disclosures:

F. Sahoo, Merck Research Laboratories: Investigator, Research support

H. Xie, None

W. Leisenring, None

S. Goyal, Merck Research Laboratories: Investigator, Research support

J. Yi, None

L. Kimball, None

I. Lee, Merck Research Laboratories: Employee and Shareholder, Salary

J. Hill, None

S. Seo, None

C. Davis, None

S. Pergam, Merck Research Laboratories: Consultant and Research Contractor, Consulting fee and Research support

K. L. Liaw, Merck Research Laboratories: Employee and Shareholder, Salary

L. Holmberg, None

M. Boeckh, Merck Research Laboratories: Consultant and Research Contractor, Consulting fee and Research support
GSK: Consultant and Research Contractor, Consulting fee and Research support

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