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Varicella-zoster virus infection after marrow transplantation for aplastic anemia or leukemia
Abstract:
Nearly one-half of marrow transplant recipients who survive at least 6 months develop varicella-zoster virus (VZV) infection. Of 92 cases studied, 82 occurred within the first 12 months after transplant. Only one patient had recurrent infection. Seventy-seven patients had herpes zoster, 22 with subsequent cutaneous dissemination, and 15 had varicella. The overall mortality rate was 8%, and all deaths occurred within 9 months of transplant. Twenty-six of 32 patients studied had significant rises in VZV antibody during recovery. Among patients with acute leukemia, those with syngeneic transplants had a significantly lower incidence of VZV infection than those with allogeneic transplants. Incidence was slightly, but not significantly, decreased among patients with aplastic anemia. In contrast to other infections, the incidence of VZV infection was not influenced by graft-versus-host disease or predicted by the results of dinitrochlorobenzene skin testing.
Insights
Varicella-zoster virus (VZV) infection is common after marrow transplants, with most cases occurring within a year. Mortality from VZV post-transplant is 8%, primarily in the first nine months.
Area of Science:
- Immunology
- Infectious Diseases
- Hematology
Background:
- Marrow transplantation is a life-saving procedure for various hematologic malignancies and other conditions.
- Post-transplant infections pose a significant risk to recipients, impacting survival and quality of life.
- Varicella-zoster virus (VZV) reactivation is a notable concern in immunocompromised individuals, including transplant recipients.
Purpose of the Study:
- To investigate the incidence, clinical manifestations, and outcomes of VZV infections in marrow transplant recipients.
- To identify risk factors and patient subgroups associated with VZV infection post-transplant.
- To evaluate the impact of VZV infection on mortality in this patient population.
Main Methods:
- Retrospective analysis of 92 cases of VZV infection in marrow transplant recipients.
- Data collection included timing of infection, clinical presentation (herpes zoster, varicella, dissemination), and outcomes.
- Comparison of VZV incidence between different transplant types (syngeneic vs. allogeneic) and underlying diseases (acute leukemia, aplastic anemia).
Main Results:
- Nearly 50% of marrow transplant recipients surviving at least 6 months developed VZV infection, with 82% occurring within 12 months post-transplant.
- Herpes zoster was the predominant form (77 cases), with 22 experiencing cutaneous dissemination; 15 cases of varicella were observed.
- The overall mortality rate was 8%, with all deaths occurring within 9 months of transplant. Syngeneic transplants for acute leukemia showed a significantly lower VZV incidence than allogeneic transplants.
Conclusions:
- VZV infection is a frequent complication following marrow transplantation, primarily occurring within the first year.
- Herpes zoster with or without dissemination is the most common VZV manifestation, associated with an 8% mortality rate, particularly in early post-transplant period.
- Transplant type (syngeneic vs. allogeneic) influences VZV incidence in acute leukemia patients, while graft-versus-host disease and skin testing do not predict VZV infection.