Session: Poster Abstract Session: Transplants: Infection Epidemiology and Outcome in Stem Cell Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Background: Although acyclovir prophylaxis has led to major reductions in herpes simplex virus (HSV)-related complications among hematopoietic cell transplant (HCT) recipients, there are no data on the association between HSV serologic status and mortality post-HCT. We sought to compare outcomes in HCT recipients based on pre-transplant HSV-1 and HSV-2 serostatus among a cohort of patients receiving prolonged (minimum 1 year for VZV seropositivity) acyclovir prophylaxis.

Methods: Patients >= 18 years of age receiving their first allogenic transplant at Fred Hutchinson Cancer Research Center (FHCRC) from 2002 – 2012 were included in this retrospective cohort study. HSV serostatus was ascertained by HSV type-specific western blot prior to HCT. Patients were defined as positive for HSV-1, HSV-2, or both. We estimated the effect of survival outcomes at one year post-HCT based on HSV-1 and HSV-2 serostatus using a Cox proportional hazards model with covariates determined a priori including age, sex, graft type, donor relationship, disease risk, conditioning intensity, and Cytomegalovirus serostatus; acute graft-versus-host disease was added as a time dependent covariate.

Results: A total of 2035 adult patients were included in the cohort. The median age at time of transplant was 51 (IQR: 38.4-59.7). The cohort includes 1605 (79%) seropositive for HSV-1, 453 (22%) seropositive for HSV-2 (315 [15%] dual seropositive); 292 [14%] were seronegative for both. A total of 712 persons (35%) died within the first year after transplant. In a univariate model, HSV-1 seropositivity was significantly associated with mortality, (HR=1.32; 95% CI 1.13-1.54; p =0.0004) and this effect remained in a multivariate model (HR 1.35; 95% CI 1.11-1.66; p = .003). HSV-2 seropositivity, however, was neither associated with mortality in a univariate model (HR 1.02; 95% CI 0.88-1.18; p=0.77), nor in a multivariate model (HR 0.91; 95% CI 0.76-1.09; p = 0.31).

Conclusion: These results demonstrate a significant association between HSV-1 seropositivity and mortality in HCT recipients, despite the use of acyclovir prophylaxis in this cohort. Further studies aimed at examining the possible biological mechanisms for causality are warranted.

Zach Stednick, MPH1, Christine Johnston, MD, MPH2, Michael Boeckh, MD, FIDSA1,2,3, Ted Gooley, PhD3 and Steven a Pergam, MD, MPH, FIDSA1,2,3, (1)Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, (2)Department of Medicine, University of Washington, Seattle, WA, (3)Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA


Z. Stednick, None

C. Johnston, Sanofi: Investigator , Research support
Genocea: Investigator , Research support
Agenus: Investigator , Research support
Vical: Investigator , Research support

M. Boeckh, Chimerix: Consultant , Consulting fee and Research support
Genentech/Roche: Consultant , Consulting fee and Research support

T. Gooley, None

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

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.