Varicella-zoster virus-specific cell-mediated immunity and herpes zoster development in multiple myeloma patients receiving bortezomib- or thalidomide-based chemotherapy

Ji Won Kim, Chang Ki Min, Yeung Chul Mun, Yong Park, Byung Soo Kim, Seung Hyun Nam, Youngil Koh, Ji Hyun Kwon, Pyoeng Gyun Choe, Wan Beom Park, Inho Kim

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background: The incidence of herpes zoster is substantial during bortezomib treatment in patients with multiple myeloma (MM). Objectives: This study aimed to elucidate the effect of chemotherapy with or without bortezomib in MM patients on their herpes zoster incidence and varicella zoster virus (VZV)-specific cell-mediated immunity (CMI). Study design: Peripheral blood mononuclear cells were collected at baseline and after 1 month of bortezomib-based or thalidomide-based chemotherapy and then analyzed using VZV-specific interferon-gamma (IFN-γ) enzyme-linked immunospot (ELISPOT) assay. The clinical data from these patients were analyzed in relation to the ELISPOT results. Results: Of 58 patients analyzed, 39 patients received bortezomib and the other 19 patients, thalidomide. Among them, 5 patients developed herpes zoster during chemotherapy; all 5 were being treated with the bortezomib-based regimen and were not receiving prophylactic anti-viral agents. The median onset of herpes zoster was 32 days (range, 15-95 days) from the initiation of chemotherapy. Among patients who received bortezomib therapy, acyclovir prophylaxis significantly reduced the risk for herpes zoster (100-day cumulative incidence, 0% vs. 49.5%; p<0.001). Spot-forming cell (SFC) counts in the IFN-γ ELISPOT assay decreased from baseline after bortezomib (p=0.011) or thalidomide (p=0.096) treatment. Patients with baseline SFCs greater than 20/106 mononuclear cells exhibited significantly higher incidence of herpes zoster (100-day cumulative incidence, 34.8% vs. 0%; p=0.040). Conclusions: Bortezomib treatment significantly reduced VZV-specific CMI, and high baseline SFC counts in patients receiving this treatment without acyclovir prophylaxis were associated with a significantly increased risk for herpes zoster.

Original languageEnglish
Pages (from-to)64-69
Number of pages6
JournalJournal of Clinical Virology
StatePublished - 1 Dec 2015

Bibliographical note

Funding Information:
This work was supported by a grant ( No. 04-2012-0780 ) from the Seoul National University Hospital Research Fund , Seoul, Korea; a grant ( No. 0720142084 ) from the National Research Foundation of Korea , Seoul, Korea; and a grant from the Janssen Pharmaceutical Company of Johnson & Johnson , Seoul, Korea.

Publisher Copyright:
© 2015 Elsevier B.V.


  • Bortezomib
  • Enzyme-linked immunospot assay
  • Herpes zoster
  • Multiple myeloma
  • Varicella-zoster virus


Dive into the research topics of 'Varicella-zoster virus-specific cell-mediated immunity and herpes zoster development in multiple myeloma patients receiving bortezomib- or thalidomide-based chemotherapy'. Together they form a unique fingerprint.

Cite this