Xue Elisabetta, Xie Hu, Leisenring Wendy M, Kimball Louise E, Goyal Sonia, Chung Lisa, Blazevic Rachel, Maltez Byron, Edwards Anna, Dahlberg Ann E, Salit Rachel B, Delaney Colleen, Pergam Steven A, Boeckh Michael, Milano Filippo, Hill Joshua A
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Hematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.
Clin Infect Dis. 2021 Apr 26;72(8):1350-1357. doi: 10.1093/cid/ciaa222.
Cord blood transplant (CBT) recipients have a high incidence of herpes zoster (HZ) in the context of short-term peritransplant antiviral prophylaxis. In 2009, international guidelines recommended HZ prophylaxis for at least 1 year after hematopoietic cell transplant. The impact of longer-term antiviral prophylaxis on HZ incidence after CBT is unknown.
We retrospectively analyzed varicella zoster virus (VZV)-seropositive CBT recipients who were transplanted between 2006 and 2016. We abstracted HZ events and other variables for up to 5 years post-CBT. We calculated the cumulative incidence of HZ and used Cox proportional hazards regression to identify variables associated with HZ.
The study cohort consisted of 227 patients. Among 1-year survivors, 91% were still receiving prophylaxis, for a median duration of 20.6 months. HZ occurred in 44 patients (19%) at a median of 23.6 months. The cumulative incidence of HZ by 1 year after CBT was 1.8% (95% confidence interval [CI], .1%-4%), but increased to 26% (95% CI, 19%-33%) by 5 years. In a multivariable analysis, acute graft-vs-host disease was associated with increased risk, whereas antiviral prophylaxis was associated with reduced risk for HZ (adjusted hazard ratio, 0.19 [95% CI, .09-.4]). There was no association between CD4+ T-cell counts at 1 year post-CBT and subsequent risk for HZ.
We found a high incidence of HZ after CBT despite antiviral prophylaxis for > 1 year. Based on these findings, we suggest longer duration of prophylaxis for HZ after CBT. Compliance with antiviral prophylaxis, VZV-specific immune monitoring, and vaccination to mitigate HZ after CBT also require further study.
在短期移植期抗病毒预防的情况下,脐血移植(CBT)受者的带状疱疹(HZ)发病率很高。2009年,国际指南建议造血细胞移植后至少进行1年的HZ预防。长期抗病毒预防对CBT后HZ发病率的影响尚不清楚。
我们回顾性分析了2006年至2016年间接受移植的水痘带状疱疹病毒(VZV)血清阳性CBT受者。我们提取了CBT后长达5年的HZ事件和其他变量。我们计算了HZ的累积发病率,并使用Cox比例风险回归来确定与HZ相关的变量。
研究队列包括227名患者。在1年存活者中,91%仍在接受预防,中位持续时间为20.6个月。44名患者(19%)发生HZ,中位时间为23.6个月。CBT后1年HZ的累积发病率为1.8%(95%置信区间[CI],0.1%-4%),但到5年时增加到26%(95%CI,19%-33%)。在多变量分析中,急性移植物抗宿主病与风险增加相关,而抗病毒预防与HZ风险降低相关(调整后的风险比,0.19[95%CI,0.09-0.4])。CBT后1年时的CD4+T细胞计数与随后的HZ风险之间没有关联。
尽管进行了超过1年的抗病毒预防,我们发现CBT后HZ的发病率很高。基于这些发现,我们建议CBT后延长HZ预防的持续时间。CBT后抗病毒预防的依从性、VZV特异性免疫监测以及减轻HZ的疫苗接种也需要进一步研究。