Varicella Zoster Infection Associated with Pharmacological JAK-STAT Inhibition via Ruxolitinib in Myeloproliferative Diseases

Ruxolitinib phosphate is an inhibitor drug of the JAK family of protein kinases. The results from two Phase III studies in myelofibrosis (COMFORT-I, COMFORT-II) demonstrate the effectiveness of Ruxolitinib in patients with primary myelofibrosis (MF), post-polycythemia vera myelofibrosis (PV-MF) and post-essential thrombocythemia myelofibrosis (ET-MF). On the other hand, Ruxolitinib affects several cytokines (IL1, IL6 and TNF-a) and other immune processes (dendritic cells function and T-cell response) and has been linked to increased incidence of opportunistic and non-opportunistic infections. The JAK-inhibitor Ruxolitinib affects the dendritic cell differentiation, phenotype, and function leading to impaired T-cell activation. Varicella zoster virus (VZV) infections are usually considered as having benign clinical courses. However, it sometimes can cause potentially fatal or long term disabling outcomes, including bacterial superinfections, coagulopathies, and central nervous system manifestations. Despite the low mortality rate in the immunocompetent patients, in immunocompromised patients primary VZV infections can become life-threatening. In the literature, VZV infections related allogeneic bone marrow transplantation had also been presented. To our knowledge, there are no reported association between VZV and myeloproliferative disorders (MPD) other than the process of bone marrow transplantation. Here we describe the first cases with cutaneous manifestations of VZV infections, who receiving Ruxolitinib therapy for MPD.

Author(s): Sude Hatun Aktimur, Gokce Kubra Akkoyunlu, Umit Y Malkan, Naciye Yildirim Demirel, Mehmet Turgut and Ibrahim Haznedaroglu

Abstract | Full-Text | PDF

Share This Article