title: Safety and immunogenicity of the live attenuated varicella vaccine following T replete or T cell-depleted related and unrelated allogeneic hematopoietic cell transplantation (alloHCT).
abstract: There are limited studies assessing the live attenuated varicella vaccine following allogeneic hematopoietic cell transplantation (alloHCT). Because of the morbidity of varicella acquired after childhood, we immunized and retrospectively analyzed the safety and immunogenicity of this vaccine in 46 varicella zoster virus (VZV) seronegative patients <20 years old at HCT who achieved a CD4 cell count ≥200/μL, were off immunosuppression, and responded to ≥1 post-HCT vaccines. Two vaccinated patients lacking follow-up titers were excluded from analysis. Stem cells were derived from an HLA-matched sibling (n = 18) or an alternative (HLA mismatched related or unrelated) donor (n = 26). Median time to vaccination was 4 years. Sixty-four percent of patients seroconverted following 1 immunization. There was no significant difference in response between recipients of a matched related or alternative donor graft (P = .2) or between those given a T cell-depleted or T-replete alternative donor graft (P = .27). Three of 44 patients developed a self-limited varicella-like rash within 2.5 weeks of immunization. With a median follow-up of 29.1 (range: 6.9-167.1) months, there were no subsequent cases of varicella-like rashes. No patient developed shingles. This study suggests that this vaccine is safe and immunogenic when given according to preset clinical and immunologic milestones, warranting larger prospective studies in patients ≥24 months following HCT as outlined in current post-HCT vaccine guidelines.
authors.affiliation: Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York City, NY 10065, USA.
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Chou
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Kernan
authors.forename: Susan
authors.initials: S
authors.lastname: Prockop
authors.forename: Glenn
authors.initials: G
authors.lastname: Heller
authors.forename: Andromachi
authors.initials: A
authors.lastname: Scaradavou
authors.forename: Rachel
authors.initials: R
authors.lastname: Kobos
authors.forename: Molly A
authors.initials: MA
authors.lastname: Knowles
authors.forename: Esperanza B
authors.initials: EB
authors.lastname: Papadopoulos
authors.forename: Anne
authors.initials: A
authors.lastname: Casson
authors.forename: Catherine
authors.initials: C
authors.lastname: Copeland
authors.forename: Joanne
authors.initials: J
authors.lastname: Torok-Castanza
authors.forename: Nicole
authors.initials: N
authors.lastname: Zakak
authors.forename: Julianne
authors.initials: J
authors.lastname: Ruggiero
authors.forename: Trudy N
authors.initials: TN
authors.lastname: Small
mesh_terms: D000293:Adolescent; D000328:Adult; D019433:Chickenpox Vaccine / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D014645:Herpesvirus 3, Human / Q000276:immunology*; D006801:Humans; D007114:Immunization; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000276:immunology*; D014184:Transplantation, Homologous / Q000379:methods*; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D055815:Young Adult
chemical_list: D019433:Chickenpox Vaccine; D014613:Vaccines, Attenuated