Related Experiment Videos
Herpes zoster infection after bone marrow transplantation in children
H Kawasaki1, J Takayama, M Ohira
1Department of Pediatrics, Kansai Medical University, Osaka, Japan.
Insights
Herpes zoster (HZ) occurred in 33% of children post-bone marrow transplant (BMT), particularly those with hematologic malignancy or total body irradiation. Early antiviral treatment with acyclovir improved outcomes.
Area of Science:
- Pediatric Hematology Oncology
- Infectious Diseases
- Transplantation Immunology
Background:
- Bone marrow transplantation (BMT) is a critical treatment for pediatric hematologic malignancies and solid tumors.
- Post-transplant complications, including viral infections, pose significant risks to pediatric patients.
- Herpes zoster (HZ), a reactivation of the varicella-zoster virus, is a known concern after immunosuppressive therapies like BMT.
Purpose of the Study:
- To investigate the incidence, risk factors, and clinical progression of herpes zoster (HZ) in pediatric patients following bone marrow transplantation (BMT).
- To identify specific patient populations at higher risk for HZ post-BMT.
- To evaluate the effectiveness of antiviral therapy in managing HZ complications in this cohort.
Main Methods:
- Retrospective analysis of 107 pediatric patients who underwent allogeneic or autologous BMT for hematologic malignancy or solid tumors.
- Data collection included patient demographics, transplant type, underlying diagnosis, conditioning regimens (specifically total body irradiation), HZ occurrence, onset, and treatment.
- Clinical course and outcomes of HZ were documented, with a focus on localized vs. disseminated disease and mortality.
Main Results:
- Herpes zoster (HZ) developed in 33% (35/107) of pediatric patients post-BMT, with a median onset of 96 days and 89% occurring within the first year.
- HZ incidence was higher in children with hematologic malignancy (58%) compared to solid tumors (27%), particularly those receiving total body irradiation.
- All patients received acyclovir for HZ, and no deaths were directly attributed to HZ complications, indicating effective management.
Conclusions:
- Herpes zoster (HZ) is a frequent complication in children undergoing bone marrow transplantation (BMT), often occurring earlier than in adults.
- Pediatric patients with hematologic malignancy and those who received total body irradiation are at increased risk for HZ post-BMT.
- Prompt administration of antiviral therapy, such as acyclovir, is crucial for reducing mortality and significant morbidity associated with HZ in this vulnerable population.
Objective:
To determine the frequency of, risk factors for, and clinical course of herpes zoster (HZ) after bone marrow transplantation (BMT) in children.
Study Design:
A total of 107 children with hematologic malignancy or solid tumor who underwent allogeneic or autologous BMT were studied retrospectively.
Results:
Of the 107 patients, HZ developed in 35 (33%) after BMT; 31 (89%) of these 35 patients had localized HZ. The median onset of infection was day 96 after BMT, and 89% of cases of HZ occurred before day 365 after BMT. HZ developed in 26 (58%) of 45 patients (13/21 (62%) allogeneic and 13/24 (54%) autologous patients) with hematologic malignancy; most of these patients had undergone total body irradiation. Of 33 patients with solid tumor, HZ developed in 9 (27%). All patients with HZ were treated with acyclovir, and no patients died of complications directly resulting from HZ.
Conclusion:
Herpes zoster occurred earlier after BMT than in adults, and it occurred frequently in children who had hematologic malignancy and/or had undergone total body irradiation. Prompt antiviral therapy reduced the mortality rate and significant morbidity associated with HZ.