Abstract：
BACKGROUND: Varicella-zoster virus (VZV) reactivation is the most common infectious complication in the late posthematopoietic stem cell transplantation (HSCT) period and is reported as 16%-41%. Acyclovir prophylaxis is recommended for at least 1 year after HSCT to prevent VZV infections. However, studies on the most appropriate prophylaxis are ongoing in pediatric patients.
METHODS: Patients who underwent allogeneic HSCT between January 1, 1996 and January 1, 2020 were retrospectively analyzed to outline the characteristics of VZV reactivation after allogeneic HSCT in pediatric patients using 6 months acyclovir prophylaxis.
RESULTS: There were 260 patients and 273 HSCTs. Median age was 10.43 (0.47-18.38), and 56% was male. Median follow-up was 2325 days (18-7579 days). VZV reactivation occurred in 21.2% (n = 58) at a median of 354 (55-3433) days post-HSCT. The peak incidence was 6-12 months post-HSCT (43.1%). Older age at HSCT, female gender, history of varicella infection, lack of varicella vaccination, low lymphocyte, CD4 count, and CD4/CD8 ratio at 9 and 12 months post-HSCT was found as a significant risk for herpes zoster (HZ) in univariate analysis, whereas history of varicella infection and low CD4/CD8 ratio at 12 months post-HSCT was an independent risk factor in multivariate analysis.
CONCLUSIONS: Tailoring acyclovir prophylaxis according to pre-HCT varicella history, posttransplant CD4 T lymphocyte counts and functions, and ongoing immunosuppression may help to reduce HZ-related morbidity and mortality.
METHODS: Patients who underwent allogeneic HSCT between January 1, 1996 and January 1, 2020 were retrospectively analyzed to outline the characteristics of VZV reactivation after allogeneic HSCT in pediatric patients using 6 months acyclovir prophylaxis.
RESULTS: There were 260 patients and 273 HSCTs. Median age was 10.43 (0.47-18.38), and 56% was male. Median follow-up was 2325 days (18-7579 days). VZV reactivation occurred in 21.2% (n = 58) at a median of 354 (55-3433) days post-HSCT. The peak incidence was 6-12 months post-HSCT (43.1%). Older age at HSCT, female gender, history of varicella infection, lack of varicella vaccination, low lymphocyte, CD4 count, and CD4/CD8 ratio at 9 and 12 months post-HSCT was found as a significant risk for herpes zoster (HZ) in univariate analysis, whereas history of varicella infection and low CD4/CD8 ratio at 12 months post-HSCT was an independent risk factor in multivariate analysis.
CONCLUSIONS: Tailoring acyclovir prophylaxis according to pre-HCT varicella history, posttransplant CD4 T lymphocyte counts and functions, and ongoing immunosuppression may help to reduce HZ-related morbidity and mortality.
摘要：
背景：水痘-带状疱疹病毒（VZV）的再激活是造血干细胞移植（HSCT）后期最常见的感染性并发症，据报道为16％-41％。建议在HSCT后至少1年预防阿昔洛韦，以预防VZV感染。然而,目前正在对儿科患者进行关于最适当预防的研究.
方法：对1996年1月1日至2020年1月1日期间接受同种异体HSCT的患者进行回顾性分析，以概述使用6个月阿昔洛韦预防的儿科患者同种异体HSCT后VZV再激活的特征。
结果：共有260例患者和273例HSCT。年龄中位数为10.43（0.47-18.38），56%是男性。中位随访时间为2325天（18-7579天）。VZV再激活发生在21.2％（n=58），中位数为HSCT后354（55-3433）天。最高发生率为HSCT后6-12个月（43.1％）。HSCT年龄较大，女性性别,水痘感染史,缺乏水痘疫苗接种，低淋巴细胞，CD4计数,在单因素分析中，发现HSCT后9个月和12个月的CD4/CD8比值是带状疱疹（HZ）的显着风险，而在多因素分析中,水痘感染史和HSCT后12个月CD4/CD8比值偏低是独立危险因素.
结论：根据HCT前水痘病史定制阿昔洛韦的预防，移植后CD4T淋巴细胞计数和功能，和持续的免疫抑制可能有助于降低HZ相关的发病率和死亡率。
方法：对1996年1月1日至2020年1月1日期间接受同种异体HSCT的患者进行回顾性分析，以概述使用6个月阿昔洛韦预防的儿科患者同种异体HSCT后VZV再激活的特征。
结果：共有260例患者和273例HSCT。年龄中位数为10.43（0.47-18.38），56%是男性。中位随访时间为2325天（18-7579天）。VZV再激活发生在21.2％（n=58），中位数为HSCT后354（55-3433）天。最高发生率为HSCT后6-12个月（43.1％）。HSCT年龄较大，女性性别,水痘感染史,缺乏水痘疫苗接种，低淋巴细胞，CD4计数,在单因素分析中，发现HSCT后9个月和12个月的CD4/CD8比值是带状疱疹（HZ）的显着风险，而在多因素分析中,水痘感染史和HSCT后12个月CD4/CD8比值偏低是独立危险因素.
结论：根据HCT前水痘病史定制阿昔洛韦的预防，移植后CD4T淋巴细胞计数和功能，和持续的免疫抑制可能有助于降低HZ相关的发病率和死亡率。
