Factors influencing the development of VZV reactivation disease after allogeneic HCT
| . | Allogeneic HCT recipients* . | 95% CI . | P . |
|---|---|---|---|
| HR . | |||
| Acyclovir prophylaxis† | |||
| No long-term acyclovir (cohort 1) | 3.3 | 2.5-4.4 | <.001 |
| 1 year of acyclovir use (cohort 2) | 1.0 | — | — |
| 1 year or more of acyclovir use (cohort 3) | 0.5 | 0.3-0.9 | .01 |
| Age, y | |||
| 0 to 49 | 1.0 | — | — |
| 50 to 73 | 0.6 | 0.4-0.9 | .01 |
| Conditioning regimen | |||
| Myeloablative with combination therapy | 1.0 | — | — |
| Myeloablative with total body irradiation | 1.5 | 1.2-2.0 | .003 |
| Nonmyeloablative | 1.2 | 0.6-2.2 | .70 |
| Tandem transplantations | 2.1 | 0.8-5.3 | .11 |
| Recipient herpes simplex virus serostatus | |||
| Negative | 1.0 | — | — |
| Positive | 0.6 | 0.5-0.8 | <.001 |
| . | Allogeneic HCT recipients* . | 95% CI . | P . |
|---|---|---|---|
| HR . | |||
| Acyclovir prophylaxis† | |||
| No long-term acyclovir (cohort 1) | 3.3 | 2.5-4.4 | <.001 |
| 1 year of acyclovir use (cohort 2) | 1.0 | — | — |
| 1 year or more of acyclovir use (cohort 3) | 0.5 | 0.3-0.9 | .01 |
| Age, y | |||
| 0 to 49 | 1.0 | — | — |
| 50 to 73 | 0.6 | 0.4-0.9 | .01 |
| Conditioning regimen | |||
| Myeloablative with combination therapy | 1.0 | — | — |
| Myeloablative with total body irradiation | 1.5 | 1.2-2.0 | .003 |
| Nonmyeloablative | 1.2 | 0.6-2.2 | .70 |
| Tandem transplantations | 2.1 | 0.8-5.3 | .11 |
| Recipient herpes simplex virus serostatus | |||
| Negative | 1.0 | — | — |
| Positive | 0.6 | 0.5-0.8 | <.001 |
Allogeneic HCT recipients: gender, race, type of cells (bone marrow or cord blood vs. peripheral blood stem cells), underlying disease (good vs bad prognosis for relapse), CMV serostatus (donor/recipient), donor HLA serostatus, chronic and acute graft-versus host disease (time-dependent covariates) were not independently associated with VZV reactivation disease.
Cohort 1: acyclovir 5 mg/kg intravenous every 8 hours or 400 mg twice daily orally until engraftment for patients who were HSV-seropositive HCT recipients. Cohort 2 and cohort 3: acyclovir 250 mg/m2 intravenous every12 hours followed by acyclovir 800 mg orally twice daily or valacyclovir 500 mg orally twice daily (valacyclovir is preferred for patients who were receiving 0.5 mg/kg or more per day of corticosteroids).