Cell-Mediated Immunity to Varicella-Zoster Virus after Allogeneic Marrow Transplant

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Abstract
The cellular immune response of normal persons and marrow transplant recipients to varicella-zoster virus (VZV) antigen was measured with use of the lymphocyte transformation response. Ninety-nine of 100 normal persons with previous VZV infection had a stimulation index of ⩾4.8, while 10 susceptible persons had responses of ⩽3.0. Before transplant, responses were lower than normal in patients with leukemia in relapse (P = 0.001), but not in patients with leukemia in remission or with aplastic anemia. Throughout the first 100 days after transplant, lymphocyte response was depressed (P < 0.0005), especially among recipients of antithymocyte globulin during days 41–80 (P < 0.05). Patients with aplastic anemia had higher responses than those with leukemia during days 20–60 (P < 0.02). By one year, most responses were normal. Long-term survivors who had recurrent VZV infection had positive responses more often than those without recurrent infection (P = 0.01). The lymphocyte response to VZV antigen paralleled, and thus may predict, periods of increased susceptibility to VZV infection.