Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Biol Blood Marrow Transplant. 2020 May;26(5):965-971. doi: 10.1016/j.bbmt.2020.01.009. Epub 2020 Jan 18.
Although long-term antiviral prophylaxis is recommended to prevent varicella zoster virus (VZV) infection in seropositive recipients of allogeneic and autologous (auto-) hematopoietic cell transplantation (HCT), studies of VZV infections in pediatric auto-HCT recipients are rare. This study aimed to investigate the incidence and characteristics of VZV infection in pediatric auto-HCT recipients and explore the risk factors of VZV infection and its effect on survival outcomes. This study included all pediatric patients who underwent auto-HCT at Samsung Medical Center, Seoul, Korea, between January 1998 and December 2013. Before 2006, short-term acyclovir prophylaxis was provided until neutrophil engraftment; thereafter, routine prophylaxis was not provided. Patients who developed either herpes zoster or chickenpox within 2 years from transplantation were identified, and a chart review was performed. A total of 413 recipients and 698 auto-HCTs were included. Sixty-one episodes of VZV infections were identified in 54 patients. Fourteen cases of VZV infection (23%; 14 of 61) occurred within 30 days after auto-HCT. The cumulative incidence of the first episode of VZV infection at 2 years after transplantation was 14% (95% confidence interval [CI], 7.9% to 22.8%) in all recipients and 9% (95% CI, 1.0 to 26.6) in VZV-seronegative patients. Notably, the VZV infection rate increased with age and the VZV infection rate in patients age 15 to 19 years was almost three times higher than in patients age 0 to 4 years (28% versus 10%; P = .003). However, there was no difference in the VZV infection rate between recipients of single auto-HCT and recipients of tandem auto-HCT. Two patients died of disseminated VZV infection. VZV infection is a considerable risk in auto-HCT recipients with or without short-term prophylaxis. Universal antiviral prophylaxis might be considered, particularly in older children, regardless of VZV serologic results. To our knowledge, this is the largest study of VZV infection in pediatric auto-HCT recipients reported to date.
尽管建议对所有异基因和自体（auto-）造血细胞移植（HCT）受者进行长期抗病毒预防以预防水痘带状疱疹病毒（VZV）感染，但儿科自体 HCT 受者的 VZV 感染研究很少。本研究旨在调查儿科自体 HCT 受者 VZV 感染的发生率和特征，并探讨 VZV 感染的危险因素及其对生存结果的影响。本研究纳入了 1998 年 1 月至 2013 年 12 月期间在韩国首尔三星医疗中心接受自体 HCT 的所有儿科患者。在 2006 年之前，提供短期阿昔洛韦预防治疗直至中性粒细胞植入；此后，不常规提供预防治疗。确定了在移植后 2 年内发生带状疱疹或水痘的患者，并进行了病历回顾。共纳入 413 例受者和 698 例自体 HCT。在 54 例患者中发现了 61 例 VZV 感染。14 例 VZV 感染（23%；61 例中的 14 例）发生在自体 HCT 后 30 天内。移植后 2 年内首次 VZV 感染的累积发生率在所有受者中为 14%（95%置信区间 [CI]，7.9%至 22.8%），在 VZV 血清阴性患者中为 9%（95% CI，1.0 至 26.6）。值得注意的是，VZV 感染率随年龄增加而增加，15 至 19 岁患者的 VZV 感染率几乎是 0 至 4 岁患者的三倍（28%对 10%；P =.003）。然而，单次自体 HCT 受者和串联自体 HCT 受者的 VZV 感染率没有差异。2 例患者死于播散性 VZV 感染。无论短期预防治疗如何，自体 HCT 受者均存在 VZV 感染的重大风险。无论 VZV 血清学结果如何，都可能考虑使用通用抗病毒预防治疗，特别是在大龄儿童中。据我们所知，这是迄今为止报道的最大规模的儿科自体 HCT 受者 VZV 感染研究。
