VZV Prophylaxis After Allogeneic Hematopoietic Stem Cell Transplantation in Children: When to Stop?
ABSTRACT Background Acyclovir treatment is an efficient prophylaxis to prevent varicella‐zoster virus (VZV) reactivation after allogeneic hematopoietic stem cell transplantation (HSCT). Aims This single center retrospective study tried to determine if the lymphocytes immunophenotyping could help to...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-11-01
|
| Series: | Cancer Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cnr2.70015 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846151900852912128 |
|---|---|
| author | Eva deBerranger Anne‐Flore Derache Nassima Ramdane Julien Labreuche Pauline Navarin Fanny Gonzales Wadih Abou‐Chahla Brigitte Nelken Bénédicte Bruno |
| author_facet | Eva deBerranger Anne‐Flore Derache Nassima Ramdane Julien Labreuche Pauline Navarin Fanny Gonzales Wadih Abou‐Chahla Brigitte Nelken Bénédicte Bruno |
| author_sort | Eva deBerranger |
| collection | DOAJ |
| description | ABSTRACT Background Acyclovir treatment is an efficient prophylaxis to prevent varicella‐zoster virus (VZV) reactivation after allogeneic hematopoietic stem cell transplantation (HSCT). Aims This single center retrospective study tried to determine if the lymphocytes immunophenotyping could help to determine the duration of prophylaxis, and evaluated complications, and associated risk factors for VZV infection. Methods and Results Eighty‐four children underwent an allogeneic HSCT, in which 77 received an acyclovir prophylaxis. Twenty‐one of the 77 had a VZV infection with an incidence rate of 1.30 per 100 patients‐months (exact 95% CI, 0.81 to 2.01). Among these 21 patients with VZV infection, 16 had an infection after withdrawing acyclovir prophylaxis within a median of 49 days (range, 11 days–5.8 months). Thirty‐five percent of the VZV infected patients were hospitalized, 9% had a visceral dissemination, and 9% had postherpetic neuralgia. In multivariate analysis, higher VZV infection rate was associated with conditioning regimen with total body irradiation, immunoglobulin substitution, and antithymocyte globulin. The incidence of VZV infection increased significantly when patients had a CD4+ lymphocytes count below 23% (cHR 3.28 [95% CI, 1.09–9.81]; p = 0.03) or a CD4+/CD8+ ratio less than 0.9 (cHR 3.13 [95% CI, 1.04–9.36]; p = 0.04) at the time of stopping acyclovir prophylaxis. Conclusion After cessation of acyclovir prophylaxis, VZV reactivation can occur and be responsible for morbidity after allogeneic HSCT. This study suggests that the proportion of CD4+ lymphocytes and the CD4+/CD8+ ratio can inform decisions about the duration of acyclovir prophylaxis after allogeneic HSCT to prevent VZV reactivation. |
| format | Article |
| id | doaj-art-4ca920f2089d45bb8c2e4dcb930b3e1e |
| institution | Kabale University |
| issn | 2573-8348 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Reports |
| spelling | doaj-art-4ca920f2089d45bb8c2e4dcb930b3e1e2024-11-27T03:18:39ZengWileyCancer Reports2573-83482024-11-01711n/an/a10.1002/cnr2.70015VZV Prophylaxis After Allogeneic Hematopoietic Stem Cell Transplantation in Children: When to Stop?Eva deBerranger0Anne‐Flore Derache1Nassima Ramdane2Julien Labreuche3Pauline Navarin4Fanny Gonzales5Wadih Abou‐Chahla6Brigitte Nelken7Bénédicte Bruno8Paediatric Hematology Lille FrancePaediatric Hematology Lille FranceDepartment of Biostatistics Lille FranceDepartment of Biostatistics Lille FrancePaediatric Hematology Lille FrancePaediatric Hematology Lille FrancePaediatric Hematology Lille FrancePaediatric Hematology Lille FrancePaediatric Hematology Lille FranceABSTRACT Background Acyclovir treatment is an efficient prophylaxis to prevent varicella‐zoster virus (VZV) reactivation after allogeneic hematopoietic stem cell transplantation (HSCT). Aims This single center retrospective study tried to determine if the lymphocytes immunophenotyping could help to determine the duration of prophylaxis, and evaluated complications, and associated risk factors for VZV infection. Methods and Results Eighty‐four children underwent an allogeneic HSCT, in which 77 received an acyclovir prophylaxis. Twenty‐one of the 77 had a VZV infection with an incidence rate of 1.30 per 100 patients‐months (exact 95% CI, 0.81 to 2.01). Among these 21 patients with VZV infection, 16 had an infection after withdrawing acyclovir prophylaxis within a median of 49 days (range, 11 days–5.8 months). Thirty‐five percent of the VZV infected patients were hospitalized, 9% had a visceral dissemination, and 9% had postherpetic neuralgia. In multivariate analysis, higher VZV infection rate was associated with conditioning regimen with total body irradiation, immunoglobulin substitution, and antithymocyte globulin. The incidence of VZV infection increased significantly when patients had a CD4+ lymphocytes count below 23% (cHR 3.28 [95% CI, 1.09–9.81]; p = 0.03) or a CD4+/CD8+ ratio less than 0.9 (cHR 3.13 [95% CI, 1.04–9.36]; p = 0.04) at the time of stopping acyclovir prophylaxis. Conclusion After cessation of acyclovir prophylaxis, VZV reactivation can occur and be responsible for morbidity after allogeneic HSCT. This study suggests that the proportion of CD4+ lymphocytes and the CD4+/CD8+ ratio can inform decisions about the duration of acyclovir prophylaxis after allogeneic HSCT to prevent VZV reactivation.https://doi.org/10.1002/cnr2.70015acyclovir prophylaxisallogeneic hematopoietic stem cell transplantationchildrenherpes zosterlymphocytes immunophenotypingVZV infection |
| spellingShingle | Eva deBerranger Anne‐Flore Derache Nassima Ramdane Julien Labreuche Pauline Navarin Fanny Gonzales Wadih Abou‐Chahla Brigitte Nelken Bénédicte Bruno VZV Prophylaxis After Allogeneic Hematopoietic Stem Cell Transplantation in Children: When to Stop? Cancer Reports acyclovir prophylaxis allogeneic hematopoietic stem cell transplantation children herpes zoster lymphocytes immunophenotyping VZV infection |
| title | VZV Prophylaxis After Allogeneic Hematopoietic Stem Cell Transplantation in Children: When to Stop? |
| title_full | VZV Prophylaxis After Allogeneic Hematopoietic Stem Cell Transplantation in Children: When to Stop? |
| title_fullStr | VZV Prophylaxis After Allogeneic Hematopoietic Stem Cell Transplantation in Children: When to Stop? |
| title_full_unstemmed | VZV Prophylaxis After Allogeneic Hematopoietic Stem Cell Transplantation in Children: When to Stop? |
| title_short | VZV Prophylaxis After Allogeneic Hematopoietic Stem Cell Transplantation in Children: When to Stop? |
| title_sort | vzv prophylaxis after allogeneic hematopoietic stem cell transplantation in children when to stop |
| topic | acyclovir prophylaxis allogeneic hematopoietic stem cell transplantation children herpes zoster lymphocytes immunophenotyping VZV infection |
| url | https://doi.org/10.1002/cnr2.70015 |
| work_keys_str_mv | AT evadeberranger vzvprophylaxisafterallogeneichematopoieticstemcelltransplantationinchildrenwhentostop AT anneflorederache vzvprophylaxisafterallogeneichematopoieticstemcelltransplantationinchildrenwhentostop AT nassimaramdane vzvprophylaxisafterallogeneichematopoieticstemcelltransplantationinchildrenwhentostop AT julienlabreuche vzvprophylaxisafterallogeneichematopoieticstemcelltransplantationinchildrenwhentostop AT paulinenavarin vzvprophylaxisafterallogeneichematopoieticstemcelltransplantationinchildrenwhentostop AT fannygonzales vzvprophylaxisafterallogeneichematopoieticstemcelltransplantationinchildrenwhentostop AT wadihabouchahla vzvprophylaxisafterallogeneichematopoieticstemcelltransplantationinchildrenwhentostop AT brigittenelken vzvprophylaxisafterallogeneichematopoieticstemcelltransplantationinchildrenwhentostop AT benedictebruno vzvprophylaxisafterallogeneichematopoieticstemcelltransplantationinchildrenwhentostop |