Experience with use of Zostavax® in patients with hematologic malignancy and hematopoietic cell transplant recipients

Compared with immunocompetent hosts, patients with hematologic malignancy and hematopoietic cell transplant (HCT) recipients have increased rates of herpes zoster (HZ) and are at higher risk for disseminated disease, complications such as bacterial superinfection, postherpetic neuralgia, and death (Cohen, J Infect Dis 2008;197 Suppl 2:S237-241; Locksley, et al., J Infect Dis 1985;152:1172-1181; Mazur and Dolin, Am J Med 1978;65:738-744; Schimpffer, et al., Ann Intern Med 1972;76:241-254; Schuchter, et al., Blood 1989;74:1424-1427). Improved strategies for prevention are needed to reduce the morbidity associated with HZ in these patients. While Zostavax(R) is FDA-approved for healthy adults >= 50-years-old, there are no published data on its safety and efficacy among immunocompromised patients. We retrospectively assessed our experience with the use of Zostavax(R) among 62 patients with hematologic malignancy, of whom 26 (41.9%) and 5 (8.1%) received an autologous and allogeneic HCT, respectively. The median time to vaccination post-transplant was 482 days (range, 173-4,334 days) and 1,323 days (range, 703-2,406 days) for autologous and allogeneic HCT recipients, respectively. The median duration of patient follow-up post-vaccination was 268.5 days (range, 51-947 days). There were no documented adverse reactions. A single patient developed HZ during the study period. Although further research is clearly needed, these data suggest that Zostavax(R) may be received safely in select patients with hematologic malignancy on minimal or no immunosuppressive therapy.