The occurrence of varicella zoster virus (VZV) reactivation is increased after allogeneic transplantation, whereas limited data are available for herpes zoster (HZ) after autologous SCT (ASCT). We determined the incidence and the prognostic significance of HZ and its correlation with VZV serology in 191 consecutive myeloma patients undergoing high-dose melphalan chemotherapy with ASCT. We found that VZV reactivation occurred in 57 (30%) patients, in 8.5% during induction and in 21.5% after ASCT peaking at 8 months after ASCT. Disease burden due to HZ was assessed as high or rather high in 70% of the patients. By immune fluorescence and Serion Elisa VZV IgG assessment, 90.8% of all patients had specific anti-VZV antibodies at ASCT. Lower specific antibody titers at transplantation were observed in patients with HZ after ASCT than in those without reactivation (P=0.009). Finally, OS was better in myeloma patients with HZ after ASCT compared with patients without HZ (P=0.007). Our data indicate that VZV reactivation after ASCT is a frequent event carrying a significant disease burden and it is associated with improved survival. Low levels of specific VZV antibodies at ASCT suggest increased vulnerability for VZV reactivation.
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We thank Marion Bleckmann, Barbara Muster and Irene Briner for generous help with data collection. This work was supported by a grant from the Swiss National Science Foundation (#310030-143584 to TP) and from the Swiss Cancer League (KLS-2520-02-2010 to TP).
CK performed research, analyzed data and wrote the paper, SZ analyzed data and contributed vital material; FS performed research; DB contributed vital material; TZ contributed vital material; TP designed research, analyzed data and wrote the paper.
The authors declare no conflict of interest.
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Kamber, C., Zimmerli, S., Suter-Riniker, F. et al. Varicella zoster virus reactivation after autologous SCT is a frequent event and associated with favorable outcome in myeloma patients. Bone Marrow Transplant 50, 573–578 (2015). https://doi.org/10.1038/bmt.2014.290
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