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Herpes zoster in children with bone marrow transplantation: Report from a single institution
H Nakayama1, J Okamura, S Ohga
1Section of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan.
Insights
Herpes zoster (HZ) frequently occurs in children post-bone marrow transplant (BMT), typically around 100 days. This risk is linked to specific treatments and immune cell imbalances, particularly T lymphocytes.
Area of Science:
- Pediatric Hematology
- Immunology
- Infectious Diseases
Background:
- Herpes zoster (HZ) is a common complication following pediatric bone marrow transplantation (BMT).
- Understanding risk factors and timing is crucial for managing HZ in this vulnerable population.
Purpose of the Study:
- To investigate the clinical features and incidence of HZ in children undergoing BMT.
- To identify factors associated with HZ development and analyze lymphocyte subset changes in relation to HZ occurrence.
Main Methods:
- Retrospective review of 44 children who underwent BMT.
- Comparison of clinical factors and lymphocyte subsets (CD3+, CD4+, CD8+) between HZ-positive and HZ-negative groups.
- Analysis of HZ occurrence timing and correlation with BMT conditioning regimens and graft-versus-host disease (GVHD).
Main Results:
- 50% of pediatric BMT recipients developed HZ, with a median onset of 101 days post-BMT.
- HZ incidence was higher in patients treated with busulfan and those experiencing Grade II-IV acute GVHD.
- HZ-positive patients showed significantly lower lymphocyte counts and altered CD4/CD8 ratios at 1 and 3 months post-BMT compared to controls.
Conclusions:
- Pediatric BMT recipients are highly susceptible to HZ around 100 days post-transplant.
- Busulfan treatment and acute GVHD are associated with increased HZ risk.
- Imbalances in T lymphocyte subsets, particularly a lower CD4/CD8 ratio, may contribute to HZ development after BMT.
Abstract:
Herpes zoster (HZ) has been often observed after bone marrow transplantation (BMT) in childhood. The occurrence of HZ was reviewed in children who received BMT. The clinical features of HZ were reviewed in 44 children who underwent BMT at Kyushu Cancer Center. Among the 35 recipients with a history of varicella before BMT, several factors associated with BMT and the lymphocyte subsets were compared between the patients who developed HZ (HZ+ group) and those who did not (HZ- group). Twenty-two recipients (50%) developed HZ; in two-thirds of these cases (15/22: 68%), HZ occurred between 80 and 120 days after BMT (median 101 days). The recipients treated with busulfan had a higher occurrence of HZ than those treated without it. The patients with Grade II-IV acute graft-versus-host disease (GVHD) developed HZ more frequently. In the HZ+ group, the absolute number of lymphocytes, CD3+, CD4+ or CD8+ cells at 3 months was significantly lower than that observed at 12 months after BMT and the CD4/CD8 ratio was significantly lower at 1 month than after 3 months of BMT. In conclusion, recipients were susceptible to HZ at around 100 days after BMT. The development of HZ may be associated with unbalanced T lymphocytes at that time.