Analysis of risk factors for varicella-zoster virus infection after allogeneic hematopoietic stem cell transplantation

doi:10.12307/2023.728

Abstract

Abstract: BACKGROUND: Allogeneic hematopoietic stem cell transplantation is an important or even the only method to cure a variety of hematological diseases. Herpes zoster virus infection after transplantation seriously affects the quality of life.
OBJECTIVE: To explore the risk factors of varicella-zoster virus infection in patients after allogeneic hematopoietic stem cell transplantation, in order to reduce the incidence of varicella-zoster virus infection after allogeneic hematopoietic stem cell transplantation and the severity of the disease.
METHODS: Clinical data of 654 patients who underwent allogeneic hematopoietic stem cell transplantation in the First Affiliated Hospital of Zhengzhou University from November 2016 to June 2021 were retrospectively analyzed to explore the related factors of the varicella-zoster virus infection after allogeneic hematopoietic stem cell transplantation.
RESULTS AND CONCLUSION: 66 of the 654 patients developed varicella-zoster virus infection after allogeneic hematopoietic stem cell transplantation, and the morbidity was 10.1%. The average age of patients who infected with varicella-zoster virus was 21.5 (4-62) years old, and the average time of varicella-zoster virus infection was 149 days (19-1 179 days). The main manifestations were regional skin herpes, including 7 cases of herpes zoster encephalitis, 17 cases of post herpetic neuralgia, and 1 case of right ear deafness. The main treatments were topical use of ganciclovir gel, intravenous infusion of penciclovir, application of immunoglobulin to improve immune function and reduce the dosage of immunosuppressant. The median time of treatment was 11 days (3-38 days), and the herpes was scabbed or improved. Incidence of varicella-zoster virus infection after allogeneic hematopoietic stem cell transplantation was related to age (χ2= 7.816, P=0.005), whether fludarabine was used in the pretreatment scheme (χ2=5.004, P=0.025), whether there was cytomegalovirus infection (χ2=5.983, P=0.014), and the primary diseases (χ2=4.860, P=0.027). It was not related to the type of transplantation and the source of stem cells. The varicella-zoster virus infection is a common complication of allogeneic hematopoietic stem cell transplantation. It usually occurs within one year after transplantation. Patients with risk factors should pay more attention to prevention and treatment. Preventive application of antiviral drugs can reduce the incidence of varicella-zoster virus infection.

Key words: allogeneic hematopoietic stem cell transplantation, varicella-zoster virus, complication, infection, prevention

CLC Number:

Qin Jing, Zhang Suping, Li Li, Zhang Ran, Peng Yingnan, Gao Siyu, Fan Jinpeng, Bian Zhilei, Wan Dingming. Analysis of risk factors for varicella-zoster virus infection after allogeneic hematopoietic stem cell transplantation[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(33): 5292-5297.

Figures/Tables 4

2.4 发病时间发病的中位时间为149 d(19-1 179 d)，在66例VZV患者中，1年内有51例(77.3%)发生VZV感染，2年内有62例(93.9%)发生VZV感染，3年内有65例(98.5%)发生VZV感染，最长发病时间为1 179 d。 2.5 临床表现多数患者发病前可有局部皮肤的持续性疼痛，后出现成簇水疱，继而出现粟粒大小斑丘疹，常沿一侧周围神经分布，后发展为晶莹透亮的水疱。66例中13例发生于头颈或颜面部，8例为全身泛发性疱疹，41例发生于胸腰腹及会阴处，4例发生于四肢。有7例患者发生带状疱疹性脑炎，17例患者发生带状疱疹后神经痛，多数患者后遗神经痛随时间延长逐渐减轻，1例患者右耳失聪。 2.6 治疗情况 ①局部治疗：应用更昔洛韦眼用凝胶或重组人干扰素α-2b凝胶局部外用涂抹，水疱较大者碘伏消毒后予以抽吸疱液；②抗病毒治疗：静脉输注阿糖腺苷、喷昔洛韦或膦甲酸钠，或口服阿昔洛韦治疗，合并巨细胞病毒感染者可应用更昔洛韦治疗；③支持治疗：66例中有40例予以静脉输注丙种球蛋白400 mg/(kg?d)提高免疫力；④对症治疗：有明显神经痛者给予止痛药物及甲钴胺等营养神经治疗，合并感染者给予相应的抗感染治疗。 2.7 造血重建及植入情况 66例患者均获造血重建。①粒细胞植入标准：连续3 d中性粒细胞> 0.5×109 L-1；②血小板植入标准：脱离血小板输注的情况下，连续7 d血小板> 20×109 L-1，中性粒细胞植入中位时间为13 d(9-25 d)，血小板植入中位时间为13.5 d(6-32 d)。患者血型转为供者型，患者染色体及嵌合均为供者型。 2.8 预后所有患者治疗后均出现水疱干瘪结痂，病情逐渐好转至痊愈，原疱疹部位遗留色素沉着斑，部分患者遗留疱疹后神经痛，治疗的中位时间为11 d(3-38 d)。有1例患者因发生带状疱疹感染而失聪。在66例患者中，有14例死亡，其中8例死于原发病复发，4例死于真菌感染，1例死于肝脏及肠道Ⅳ度移植物抗宿主病，1例死于脓毒血症。如图2所示，VZV组患者1年生存率为87%，2年生存率为81%，3年生存率为73%。在恶性疾病中，骨髓增生异常综合征患者预后最佳，急性淋巴细胞白血病预后最差，生存率因原发病不同而各有不同。"

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