title: Predicting risk factors for varicella zoster virus infection and postherpetic neuralgia after hematopoietic cell transplantation using ordered logistic regression analysis.
abstract: To identify risk factors for varicella zoster virus (VZV) infection and postherpetic neuralgia (PHN) after hematopoietic cell transplantation (HCT), we conducted a retrospective chart review of 163 consecutive patients who underwent HCT between November 2004 and July 2014. Overall, the male/female (M/F) ratio was 80/83, median age at HCT was 54 (range 15-69) years, and autologous/allogeneic HCT (auto/allo-HCT) ratio was 71/92. Forty-four patients [M/F, 25/19; median age, 57 (range: 16-68) years; auto/allo-HCT, 26/18] developed VZV infection after HCT. All cases were successfully treated with acyclovir (ACV) or valacyclovir, and there was no VZV-related death. Nine (20%) of the 44 patients [M/F, 5/4; median age, 58 (range: 21-63) years; auto/allo-HCT, 7/2] developed PHN after resolution of zoster. Multivariate ordered logistic analysis identified receiving immunosuppressive therapy at the cessation of ACV [odds ratio (OR) = 74.53; 95% confidence interval (CI) = 6.99-794.32; P = 0.0004] as a risk factor for VZV infection and PHN in allo-HCT recipients. However, in auto-HCT recipients, only advanced age was identified as a risk factor (OR = 1.06, 95% CI = 1.002-1.127, P = 0.0429). Our findings indicate receiving immunosuppressive therapy at the cessation of ACV is a significant risk factor for allo-HCT recipients, while advanced age is a significant risk factor for auto-HCT recipients.
authors.affiliation: Departments of Hospital Pharmacy, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. ykokanba@koto.kpu-m.ac.jp.|Pain Treatment & Palliative Care Unit, University Hospital, Kyoto, Japan. ykokanba@koto.kpu-m.ac.jp.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kanbayashi
authors.affiliation: Department of Hematology, Aiseikai Yamashina Hospital, Kyoto, Japan.|Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Kuroda
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Horiike
authors.affiliation: Pain Treatment & Palliative Care Unit, University Hospital, Kyoto, Japan.|Department of Pain Management & Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Toyoshi
authors.initials: T
authors.lastname: Hosokawa
authors.affiliation: Department of Hematology, Aiseikai Yamashina Hospital, Kyoto, Japan.|Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Taniwaki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002644:Chickenpox / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000639:trends; D014645:Herpesvirus 3, Human; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D051474:Neuralgia, Postherpetic / Q000175:diagnosis* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Hematopoietic cell transplantation; Immunosuppressive therapy; Postherpetic neuralgia; Varicella zoster virus