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Herpes zoster infection after autologous bone marrow transplantation
L M Schuchter1, J R Wingard, S Piantadosi
1Johns Hopkins Oncology Center, Baltimore.
Abstract:
One hundred fifty-three patients who underwent autologous bone marrow transplant (ABMT) were studied retrospectively to determine the frequency, outcome, and risk-factors associated with varicella-zoster infections (VZV). Forty-three patients (28%) developed VZV infection after transplant. The median onset of infection was the fifth month, with 91% of cases occurring within the first year. Thirty-three patients (77%) had localized herpes zoster, and ten patients (23%) had varicella. Cutaneous dissemination developed in 15% of patients and probable visceral dissemination developed in 5%. Overall morbidity was 25% and included scarring, alopecia, postherpetic neuralgia, and neurologic dysfunction. There were no deaths from VZV infection. The majority of patients (79%) were treated with intravenous (IV) acyclovir. The only significant risk factor associated with VZV infection was the underlying disease. VZV infection occurred most frequently in patients with Hodgkin's and non-Hodgkin's lymphoma (46%) as compared with patients with leukemia (23%) or solid tumors (9%) (P less than .002). The frequency of VZV infection in ABMT patients appears to be comparable to that reported for allogeneic BMT patients and other immunocompromised patients.
Insights
Varicella-zoster virus (VZV) infections occurred in 28% of patients after autologous bone marrow transplant (ABMT), primarily within the first year. Underlying lymphoma was a significant risk factor, but VZV infection did not cause mortality.
Area of Science:
- Infectious Diseases
- Hematology
- Oncology
Background:
- Autologous bone marrow transplant (ABMT) is a critical treatment for various hematologic and oncologic conditions.
- Immunocompromised patients, including those undergoing ABMT, are at increased risk for opportunistic infections.
- Varicella-zoster virus (VZV) reactivation or primary infection poses a significant threat in this population.
Purpose of the Study:
- To determine the incidence, clinical outcomes, and risk factors of VZV infections in patients post-ABMT.
- To characterize the types of VZV infections (herpes zoster vs. varicella) and their complications.
- To evaluate the impact of underlying disease on VZV infection frequency.
Main Methods:
- Retrospective analysis of 153 patients who underwent ABMT.
- Data collection on VZV infection occurrence, timing, clinical presentation, and complications.
- Statistical analysis to identify risk factors, with a focus on underlying malignancy.
Main Results:
- VZV infection developed in 43 patients (28%), with a median onset at 5 months post-transplant; 91% occurred within the first year.
- Localized herpes zoster (77%) was more common than varicella (23%). Disseminated disease occurred in 20% of cases.
- Significant risk factor identified: underlying Hodgkin's or non-Hodgkin's lymphoma (46% incidence) compared to leukemia (23%) or solid tumors (9%).
- Overall morbidity was 25%, including scarring and postherpetic neuralgia, but no VZV-related deaths were reported. Intravenous acyclovir was the primary treatment.
Conclusions:
- VZV infections are a common complication following ABMT, predominantly occurring within the first year.
- Patients with hematologic malignancies, particularly lymphomas, face a higher risk.
- While VZV infections can lead to significant morbidity, they are manageable and not fatal in the ABMT setting.