title: Varicella zoster virus infections following allogeneic bone marrow transplantation: frequency, risk factors, and clinical outcome.
abstract: Reactivation of varicella zoster virus (VZV) is a common event in patients undergoing allogeneic bone marrow transplantation (BMT) and may lead to life-threatening complications. We retrospectively analyzed the incidence, clinical outcome, and risk factors for VZV infections occurring within the first 5 years of transplantation in 100 consecutive adults undergoing allogeneic BMT between 1992 and 1997. Forty-one patients (41%) developed VZV reactivation a median of 227 days (range 45-346 days) post-transplantation. Twelve percent of VZV reactivation occurred in the first 100 days and 88% within the first 24 months. Among those who survived for 2 or more years after transplantation (n = 47), 59% developed VZV infection. Forty percent of patients with VZV reactivation required admission with a mean hospital stay of 7.2 days. Two patients developed encephalitis, and 1 died despite antiviral therapy. The most frequent complications were post-herpetic neuralgia and peripheral neuropathy (68%). Thoracic dermatomal zoster represented 41% of the infections; disseminated cutaneous involvement was observed in 17% of patients. No clinical or epidemiologic risk factors were associated with recurrence. Administration of ganciclovir for prevention of cytomegalovirus infection delayed the onset of VZV infection beyond 4 months (P = .06). In a further subset analysis, patients with a limited chronic graft-versus-host disease (GVHD) had a lower estimated incidence of VZV reactivation compared with those with extensive chronic GVHD (P = .11). We conclude that complications from reactivation of VZV infection are common and associated with considerable morbidity and mortality in patients undergoing allogeneic BMT.
authors.affiliation: Department of Medicine, New England Medical Center, Boston, Massachusetts, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Koc
authors.forename: K B
authors.initials: KB
authors.lastname: Miller
authors.forename: D P
authors.initials: DP
authors.lastname: Schenkein
authors.forename: J
authors.initials: J
authors.lastname: Griffith
authors.forename: M
authors.initials: M
authors.lastname: Akhtar
authors.forename: J
authors.initials: J
authors.lastname: DesJardin
authors.forename: D R
authors.initials: DR
authors.lastname: Snydman
mesh_terms: D015075:2-Aminopurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002644:Chickenpox / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D003586:Cytomegalovirus Infections / Q000517:prevention & control; D000077595:Famciclovir; D005260:Female; D006086:Graft vs Host Disease / Q000821:virology; D006562:Herpes Zoster / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D014645:Herpesvirus 3, Human / Q000254:growth & development; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010146:Pain; D012189:Retrospective Studies; D012307:Risk Factors; D012871:Skin Diseases / Q000821:virology; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D015075:2-Aminopurine; D000077595:Famciclovir; D000212:Acyclovir