Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China.
Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China.
Cancer Lett. 2024 Oct 28;603:217202. doi: 10.1016/j.canlet.2024.217202. Epub 2024 Aug 30.
The incidence of herpes zoster (HZ) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients is significantly higher than that of the general public. Although routine antiviral prophylaxis is recommended, late-onset HZ has been highlighted, yet limited information is known about its clinical features and predictors. Here, we conducted a retrospective nested case-control study to identify patients with late-onset HZ, defined as a diagnosis of HZ after 1 year of transplantation, among allo-HSCT recipients between 2012 and 2017 at Peking University People's Hospital. Three controls were matched for each patient. A total of 201 patients developed late-onset HZ. Age over 20 years, absence of neutrophil engraftment by 14 days, mental disorders, immunosuppressant use at 1 year, and a peripheral CD4+/CD8+ ratio ≥0.5 at 1 year were independent risk factors, among which the CD4+/CD8+ ratio demonstrated good discriminative power for predicting late-onset HZ. For patients with a CD4+/CD8+ ratio <0.5, patient age, neutrophil engraftment time, mental disorders, and immunosuppressant use were potential risk factors. A stratification algorithm was accordingly established, classifying the transplant recipients into three risk groups. Whether the algorithm could facilitate the administration of posttransplant antiviral prophylaxis merits further validation.
异基因造血干细胞移植（allo-HSCT）受者带状疱疹（HZ）的发病率明显高于普通人群。尽管建议常规进行抗病毒预防，但已强调出现了迟发性 HZ，但其临床特征和预测因素知之甚少。在这里，我们进行了一项回顾性巢式病例对照研究，以确定 2012 年至 2017 年期间在北京大学人民医院接受 allo-HSCT 的患者中，诊断为移植后 1 年的迟发性 HZ（定义为 HZ）患者。为每位患者匹配了 3 名对照。共有 201 例患者发生迟发性 HZ。年龄>20 岁、14 天内未出现中性粒细胞植入、精神障碍、1 年内使用免疫抑制剂以及 1 年内外周血 CD4+/CD8+比值≥0.5 是独立的危险因素，其中 CD4+/CD8+比值对预测迟发性 HZ 具有良好的判别力。对于 CD4+/CD8+比值<0.5 的患者，患者年龄、中性粒细胞植入时间、精神障碍和免疫抑制剂的使用可能是潜在的危险因素。因此建立了分层算法，将移植受者分为三个风险组。该算法是否有助于接受移植后抗病毒预防值得进一步验证。
