Varicella zoster virus infection associated with high-dose chemotherapy and autologous stem-cell rescue

A retrospective evaluation of 215 consecutive recipients of high-dose chemo therapy (HDC) and autologous stem cell rescue (ASCR) was conducted to ascer tain the incidence, temporal course, and outcome of varicella tester virus (VZV) infection. Herpes tester was identified in 40 individuals at a median of 69 days following ASCR, Six of these cases occurred at a median of 33 d ays prior to ASCR but following the initiation of high doses of stem cell m obilization chemotherapy. Twenty-five percent of patients demonstrated cuta neous or systemic dissemination and 32.5% required medical intervention for post-herpetic neuralgia, All except two individuals received antiviral che motherapy, One patient with active VZV infection died of multiorgan failure 39 days after ASCR, Multivariate analysis of risk factors disclosed the si gnificance of prophylactic acyclovir use in Herpes simplex virus seropositi ve individuals in reducing the risk of VZV infection, Moreover, the use of busulfan, thiotepa and carboplatin as the conditioning chemotherapy regimen was associated with an increased risk of subsequent VZV infection. The inc idence of VZV reactivation after HDC and ASCR is similar to that observed f ollowing bone marrow transplantation but has an earlier onset, This may be related to an earlier induction of immunosuppression by stem cell mobilizat ion chemotherapy administered prior to ASCR, We demonstrated a marked reduc tion in the proliferative and synthetic capacities of peripheral blood mono nuclear cells obtained prior to and following stem cell mobilizing chemothe rapy, Moreover, greater than 80% of VZV infections occurred within 6 months following ASCR and late cases were seldom observed compared to allogeneic and autologous bone marrow transplantation, The role of antiviral chemoprop hylaxis during the period of maximum inmunocompromise needs to be studied f urther in the HDC-ASCR setting.