Karakulska-Prystupiuk Ewa, Feliksbrot-Bratosiewicz Magdalena, Król Maria, Tomaszewska Agnieszka, Jędrzejczak Wiesław Wiktor, Basak Grzegorz Władysław
Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland.
Infect Dis Rep. 2025 May 2;17(3):48. doi: 10.3390/idr17030048.
Secondary immunodeficiencies in allo-HSCT (allogeneic hematopoietic stem cell transplantation) recipients increase the risk of viral reactivation, making vaccinations a vital issue. There is a paucity of data on the use of recombinant vaccine against herpes zoster (RZV) after allo-HSCT.
This analysis included 149 recipients of allo-HSCT, transplanted in 2012-2022, mainly due to hematological malignancies (>95%). RZV was used from 2021 to 2023 according to the current recommendations of ACIP. The ELISA method was used to assess the VZV IgG antibody titers.
VZV reactivation was diagnosed in 49 out of 149 (33%) patients before vaccination, including 5 (3%) patients with reactivation within the first year after transplantation and the remaining 44 (30%) within the subsequent three years. At that time, the majority of patients were not receiving acyclovir prophylaxis. The most common clinical manifestation of reactivation was involvement of intercostal nerves, diagnosed in 40 (81%) patients. Twenty-one recipients (median age: 41) received two doses of RZV (at a median time of 34 months after transplantation, range 12-84 months), the majority of them at an interval of 1 month. The serological post-vaccination response was confirmed in 12 recipients, with a ratio of 2.38-8.3 (median 5.095). The median number of total CD3+CD4+cells in vaccinated patients was 451/μL. Despite vaccination, four patients (19%, three with confirmed serological response) developed herpes zoster.
Herpes zoster occurred mainly in the late period after allo-HSCT after completion of acyclovir prophylaxis in over 30% of recipients. The preliminary results indicate that RZV vaccination after allo-HSCT was safe and more than 80% effective at preventing HZ, but some vaccinated individuals did experience HZ.
异基因造血干细胞移植（allo-HSCT）受者的继发性免疫缺陷会增加病毒再激活的风险，使得疫苗接种成为一个至关重要的问题。关于allo-HSCT后使用重组带状疱疹疫苗（RZV）的数据较少。
本分析纳入了2012年至2022年期间接受allo-HSCT的149名受者，主要病因是血液系统恶性肿瘤（>95%）。根据美国免疫实践咨询委员会（ACIP）的当前建议，在2021年至2023年期间使用了RZV。采用酶联免疫吸附测定（ELISA）方法评估水痘-带状疱疹病毒（VZV）IgG抗体滴度。
149名患者中有49名（33%）在接种疫苗前被诊断为VZV再激活，其中5名（3%）患者在移植后第一年内发生再激活，其余44名（30%）在随后三年内发生再激活。当时，大多数患者未接受阿昔洛韦预防。再激活最常见的临床表现是肋间神经受累，40名（81%）患者被诊断为此情况。21名受者（中位年龄：41岁）接种了两剂RZV（移植后中位时间为34个月，范围12 - 84个月），大多数接种间隔为1个月。12名受者确认了接种疫苗后的血清学反应，比值为2.38 - 8.3（中位值5.095）。接种疫苗患者的总CD3 + CD4 +细胞中位数为451/μL。尽管接种了疫苗，仍有4名患者（19%，其中3名确认有血清学反应）发生了带状疱疹。
超过30%的受者在完成阿昔洛韦预防后，带状疱疹主要发生在allo-HSCT后的晚期。初步结果表明，allo-HSCT后接种RZV是安全的，预防带状疱疹的有效性超过80%，但一些接种疫苗的个体确实发生了带状疱疹。
