Varicella-Zoster Vaccination After Allogeneic Stem Cell Transplantation

vaccination in the arm
Researchers sought to determine whether varicella-zoster virus vaccination with a recombinant vaccine would show results in patients who underwent HSCT.

A recent study examined responses to varicella-zoster virus (VZV) vaccination with a recombinant vaccine in patients who have undergone allogeneic hematopoietic stem cell transplantation (HSCT). The study results were published in the journal Vaccines (Basel).

The vaccine used in this study was an adjuvanted, recombinant vaccine containing VZV glycoprotein E as the antigen. Patients who have undergone HSCT show a high risk of infection with or reactivation of VZV. The researchers who conducted this study evaluated the response to VZV vaccination in patients who have undergone HSCT.

The study included adults in Germany who had undergone HSCT. The vaccine contained 50 mg of the glycoprotein E antigen was given in 2 doses. After vaccination against VZV with the adjuvanted, recombinant vaccine, VZV-related cellular immunity was tested in peripheral blood mononuclear cells of vaccine recipients using an interferon-gamma Enzyme-Linked Immunospot (ELISpot) assay.

For the ELISpot assay, responses were evaluated to any of the following: whole VZV antigen, a native glycoprotein, and a glycoprotein E peptide pool. Responses were additionally evaluated based on the presence or absence of prior shingles, and 4 age-matched, control individuals who did not receive HSCT were also evaluated for some comparisons.

The study included 34 female patients and 45 males who underwent VZV vaccination. A total of 36 patients had previously had shingles, compared with 43 who had not. In an ELISpot assay, responses were greatest with whole VZV antigen, compared with the other tested antigens.

Participants’ responses were evaluated prior to and after receipt of the second vaccine dose. This assay showed no significant difference in response to whole VZV antigen, but responses to the VZV glycoprotein E peptide pool rose to between 3.2- and 5.7-fold higher with the second vaccination, depending on the antigen concentration used in this test (P =.02 or P =.004, respectively).

In patients who had undergone HSCT, immune responses based on the ELISpot assay using the glycoprotein E peptide pool at a concentration of 1 mg/mL showed significant elevations after receipt of the second vaccine dose (P <.005). HSCT recipients and control individuals who did not receive HSCT showed similar levels of immune responses to the glycoprotein E protein pool prior to vaccination. However, the control population showed a 4.8-fold higher median vaccine response with the first vaccination and a 1.8-fold higher median cellular response after the second vaccination.

Responses varied in assays of different antigen based on prior shingles history. A multivariate analysis showed prior shingles history and male sex to be factors associated with greater response to the vaccine used in this study.

The study investigators considered this study to indicate that in patients who have received allogeneic HSCT, cellular immunity against VZV glycoprotein E was produced, and with prior shingles history and male sex as factors that may contribute to immunity to VZV.


Koldehoff M, Horn PA, Lindemann M. Cellular immune response after vaccination with an adjuvanted, recombinant zoster vaccine in allogeneic hematopoietic stem cell transplant recipients. Vaccines (Basel). 2022;10(5):809. doi:10.3390/vaccines10050809

This article originally appeared on Hematology Advisor