Section of Hematology/Oncology, MBRCC, West Virginia University, Morgantown, WV, USA.
Ann Hematol. 2014 Apr;93(4):677-82. doi: 10.1007/s00277-013-1913-z. Epub 2013 Oct 6.
Varicella-zoster virus (VZV) reactivation is a relatively common cause of morbidity following autologous hematopoietic cell transplant (auto-HCT). The Centers for Disease Control in 2009 recommended extending VZV prophylaxis for 1 year post-transplantation. We retrospectively analyzed rates of VZV reactivation following auto-HCT at our transplant center prior to and after the implementation of extended antiviral prophylaxis in June 2008. The study population was divided into three different cohorts according to the length of VZV prophylaxis as following: (1) prophylaxis until neutrophil recovery to ≥500/μL (n = 77), (2) prophylaxis for 6 months (n = 12), or (3) 12 months (n = 40) post-auto-HCT. All patients received acyclovir 400 mg oral or intravenously twice daily or valacyclovir 500 mg oral daily. For patients in whom VZV reactivation occurred, data was collected on severity of infection, time of onset, treatment, and any associated complications. One hundred twenty-nine patients undergoing auto-HCT between January 1, 2004 and January 31, 2010 were included in the study. There was a significant difference in the rates of VZV reactivation between the neutrophil recovery and 12 months prophylaxis cohorts at 14 % (n = 11) and 2 % (n = 1) (P = 0.04), respectively. VZV reactivation rate in the 6-month prophylaxis group was 17 % (n = 2), but did not reach statistical significance due to small numbers. In the subset of auto-HCT patients treated with bortezomib, 13 % (n = 2) developed VZV reactivation in the neutrophil recovery group, while no events occurred in the other two cohorts. Complications of VZV reactivation include post-herpetic neuralgia (n = 5), severe pain (n = 3), scarring (n = 1), and motor weakness (n = 1); two patients required hospitalization and three patients developed disseminated zoster. Our limited retrospective analysis suggests a significant reduction in rates of post-auto-HCT rates of VZV reactivation with extended 12 months antiviral prophylaxis. VZV reactivation is a significant complication post-auto-HCT, and extended prophylaxis appears to be safe and effective in this setting.
水痘带状疱疹病毒（VZV）再激活是自体造血细胞移植（auto-HCT）后发病率相对较高的原因。疾病控制中心于 2009 年建议将 VZV 预防治疗延长至移植后 1 年。我们回顾性分析了在我们的移植中心实施延长抗病毒预防治疗（2008 年 6 月）前后，auto-HCT 后 VZV 再激活的发生率。根据 VZV 预防治疗的时间长短，研究人群分为三组：（1）中性粒细胞恢复至≥500/μL 时停药（n=77），（2）预防治疗 6 个月（n=12），或（3）12 个月（n=40）后停药。所有患者均接受阿昔洛韦 400mg 口服或静脉滴注，每日 2 次，或伐昔洛韦 500mg 口服，每日 1 次。对于发生 VZV 再激活的患者，收集感染严重程度、发病时间、治疗方法以及任何相关并发症的数据。研究纳入了 2004 年 1 月 1 日至 2010 年 1 月 31 日期间接受 auto-HCT 的 129 例患者。中性粒细胞恢复和 12 个月预防组的 VZV 再激活率分别为 14%（n=11）和 2%（n=1），差异有统计学意义（P=0.04）。6 个月预防组的 VZV 再激活率为 17%（n=2），但由于例数较少，未达到统计学意义。在接受硼替佐米治疗的 auto-HCT 患者亚组中，中性粒细胞恢复组中有 13%（n=2）发生 VZV 再激活，而其他两组均未发生。VZV 再激活的并发症包括带状疱疹后神经痛（n=5）、剧烈疼痛（n=3）、瘢痕形成（n=1）和运动无力（n=1）；2 例患者需要住院治疗，3 例患者发生播散性带状疱疹。我们的有限回顾性分析表明，延长 12 个月抗病毒预防治疗可显著降低 auto-HCT 后 VZV 再激活的发生率。VZV 再激活是 auto-HCT 后的一个严重并发症，延长预防治疗在这种情况下似乎是安全有效的。
