Patients who underwent autologous hematopoietic stem cell transplantation (HSCT) and received the recombinant herpes zoster vaccine (Shingrix) had a lower incidence of shingles, reported the phase III Zoster Efficacy Study.
During a median 21 months of follow-up, there was at least one herpes zoster case confirmed in 49 patients who received the vaccine and in 135 patients who received placebo, with a vaccine efficacy of 68.2%, reported Keith M. Sullivan, MD, of Duke University, North Carolina, and colleagues.
The trial involved patients undergoing HSCT in 167 centres in 28 countries from July 2012 to February 2017. Participants were randomized to receive either recombinant zoster vaccine or placebo in two 0.5 ml doses. Candidates received the recombinant vaccine for 50-70 days following HSCT procedure and the placebo 1 to 2 months later. Overall, 1,864 autologous HSCT recipients received at least one dose of the vaccine.Those randomized to receive the vaccine also had reduced incidence of herpes zoster complications and duration of herpes zoster-associated pain, revealed the researchers.
Shingrix is an inactivated viral component vaccine with increased immunogenicity. It thus provides benefit for autologous transplant patients as it allows the vaccine to be given much earlier than the previous live virus vaccine.
Alison Freifeld, MD, of the University of Nebraska Medical Center, Omaha, said that the study has important implications, because while transplant patients were typically always given a zoster vaccine, the old vaccine couldn’t be administered until at least 2 years after transplantation, according to the guidelines, due to the possibility of developing disseminated vaccine strain live virus in an immunocompromised patient.
“Whether those groups would benefit in terms of earlier administration following transplant remains to be seen,” she said. “But for the autologous group, this report does represent a landmark because of the ability to prevent cases of zoster earlier after transplantation.”
Researchers pointed out that the vaccine still needs to be assessed in allogeneic transplant patients and solid organ transplant patients, who are typically more profoundly immunosuppressed and may not have the same reactogenicity as an autologous transplant patient might have following the procedure.