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Factors influencing varicella zoster virus infection after allogeneic peripheral blood stem cell transplantation: low‐dose acyclovir prophylaxis and pre‐transplant diagnosis of lymphoproliferative disorders
Author(s) -
Kim D.H.,
Messner H.,
Minden M.,
Gupta V.,
Kuruvilla J.,
Wright J.,
Lipton J.
Publication year - 2008
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/j.1399-3062.2007.00247.x
Subject(s) - medicine , varicella zoster virus , lymphoproliferative disorders , incidence (geometry) , transplantation , lymphoma , aciclovir , gastroenterology , leukemia , immunology , virus , herpesviridae , viral disease , physics , optics
Varicella zoster virus (VZV) infection is one of the frequent opportunistic infections after allogeneic bone marrow transplantation, with a high incidence of 30–50%. However, no data have been reported on VZV infection after allogeneic peripheral blood stem cell transplantation (PBSCT). Patients and methods. We report a retrospective analysis of VZV infection in 192 allogeneic PBSCT recipients. Twenty‐seven patients (14%) received long‐term prophylaxis of low‐dose acyclovir (200 mg twice daily orally ≥3 months) for recurrent oral ( n =21) or genital herpes simplex virus infection ( n =5) or for a previous history of recurrent VZV infection ( n =1). Results. Forty‐two patients (22%) developed VZV infections: localized ( n =37) and disseminated infection ( n =5). The incidence of VZV infection at 1 and 3 years was 19.3±3.3% and 36.8±5.2%, respectively. Complications included post‐herpetic neuralgia ( n =18, 43%), secondary bacterial infections ( n =3), and intracranial hemorrhage ( n =1) with 2 deaths. A higher risk factor for VZV infection was pre‐transplant diagnosis of a lymphoproliferative disorder (LPD): chronic lymphocytic leukemia, Hodgkin's disease, or non‐Hodgkin's lymphoma ( P =0.021, 52.5% in LPD vs. 32.6% in non‐LPD group). The use of low‐dose acyclovir prophylaxis ( P =0.043, 14.7% in acyclovir vs. 41.6% in nonacyclovir group) was found to be protective. Although no VZV infection episodes were noted during the period of acyclovir prophylaxis, 3 episodes of VZV infection were noted after acyclovir cessation. Conclusion. The incidence of VZV infection after PBSCT was high at 36.8%, with patients transplanted for LPDs at higher risk. The long‐term use of low‐dose acyclovir may be protective for VZV infection, although it does not completely prevent rebound of late VZV infection.