Kamber C, Zimmerli S, Suter-Riniker F, Mueller B U, Taleghani B M, Betticher D, Zander T, Pabst T
Department of Medical Oncology, University Hospital and University of Bern, Bern, Switzerland.
Department of Infectious Diseases, University Hospital and University of Bern, Bern, Switzerland.
Bone Marrow Transplant. 2015 Apr;50(4):573-8. doi: 10.1038/bmt.2014.290. Epub 2015 Jan 19.
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.
异基因移植后水痘带状疱疹病毒（VZV）再激活的发生率会升高，而关于自体干细胞移植（ASCT）后带状疱疹（HZ）的数据有限。我们确定了191例接受大剂量美法仑化疗并进行ASCT的连续性骨髓瘤患者中HZ的发生率、预后意义及其与VZV血清学的相关性。我们发现57例（30%）患者发生了VZV再激活，诱导期为8.5%，ASCT后为21.5%，在ASCT后8个月达到峰值。70%的患者中HZ所致的疾病负担被评估为高或相当高。通过免疫荧光和Serion Elisa VZV IgG评估，90.8%的患者在ASCT时有特异性抗VZV抗体。ASCT后发生HZ的患者在移植时的特异性抗体滴度低于未再激活的患者（P=0.009）。最后，ASCT后发生HZ的骨髓瘤患者的总生存期（OS）优于未发生HZ的患者（P=0.007）。我们的数据表明，ASCT后VZV再激活是常见事件，伴有显著的疾病负担，且与生存期改善相关。ASCT时特异性VZV抗体水平低表明VZV再激活的易感性增加。
