From the Guidelines
No, herpes zoster and human papillomavirus (HPV) have not been established as direct causes of chronic lymphocytic leukemia (CLL) or non-Hodgkin lymphoma (NHL). The current guidelines for the prevention and management of infectious complications in patients with CLL, as outlined in the 2024 study published in Blood Reviews 1, focus on immunization against pneumococcus, influenza, herpes zoster, and COVID-19, but do not suggest a causal link between herpes zoster or HPV and CLL or NHL.
Key Points
- Herpes zoster is caused by varicella-zoster virus reactivation and primarily causes a painful skin rash, not blood cancers like CLL or NHL.
- HPV is primarily associated with cervical, anal, and oropharyngeal cancers, not blood cancers like CLL or NHL.
- The development of CLL and NHL typically involves genetic mutations, immune system dysfunction, and other risk factors such as age, family history, and exposure to certain chemicals, rather than these specific viral infections.
- Certain viruses, such as Epstein-Barr virus, human T-cell leukemia virus type 1, hepatitis C virus, and human herpesvirus 8, are more commonly linked to certain lymphoma subtypes, but herpes zoster and HPV are not among them, as noted in the guidelines for managing infectious complications in CLL patients 1.
Recommendations
- Patients with CLL should be immunized against herpes zoster, among other infections, to prevent complications, but this does not imply a causal relationship between herpes zoster and CLL or NHL.
- Clinicians should be aware of the clinical spectrum of HSV and VZV reactivations in patients with CLL and consider preventive strategies like the adjuvanted recombinant zoster vaccine (RZV) to reduce the incidence and severity of VZV reactivations, as recommended in the guidelines 1.
From the Research
Herpes Zoster and Human Papilloma Virus
- Herpes zoster, also known as varicella-zoster virus (VZV), is a neurotropic human alpha herpes virus responsible for chickenpox and shingles 2.
- There is no direct evidence to suggest that herpes zoster causes Chronic Lymphocytic Leukemia (CLL) or Non-Hodgkin's Lymphoma (NHL).
- However, patients with CLL are susceptible to viral infections, including VZV reactivation, due to disease-related and treatment-induced immunosuppression 3, 4.
Human Papilloma Virus (HPV)
- HPV has been detected in secondary malignancies in patients with CLL, suggesting a possible association between HPV and CLL 5.
- However, the evidence is limited, and further studies are needed to confirm this association.
- There is no direct evidence to suggest that HPV causes NHL.
Immunogenicity and Safety of Herpes Zoster Vaccine
- The recombinant adjuvanted herpes zoster vaccine (RZV) has shown high efficacy in immunocompetent adults and acceptable safety in CLL and multiple myeloma patients 3, 4.
- RZV demonstrated strong immunogenicity in CLL patients, significantly boosting IgG levels, even in actively treated or heavily pretreated patients 3.
- However, the antibody response to RZV was lower in CLL patients compared to historic controls, and strategies to improve vaccine response are needed 4.