A predictive model of herpes zoster after allogeneic hematopoietic stem cell transplantation: VZV reactivation following antiviral prophylaxis discontinuation

Author:

Feng Cheng‐Jie1234,Zhao Peng1234,Fu Hai‐Xia1234,Yan Chen‐Hua1234,Wang Chen‐Cong1234,Zhu Xiao‐Lu1234,He Yun1234,Wang Feng‐Rong1234,Zhang Yuan‐Yuan1234,Mo Xiao‐Dong1234,Kong Yuan1234,Han Wei1234,Wang Jing‐Zhi1234,Wang Yu1234,Chen Huan1234,Chen Yu‐Hong1234,Zhao Xiang‐Yu1234,Chang Ying‐Jun1234,Xu Lan‐Ping1234,Liu Kai‐Yan1234,Huang Xiao‐Jun1234,Zhang Xiao‐Hui1234ORCID

Affiliation:

1. Peking University People's Hospital Peking University Institute of Hematology Beijing China

2. Collaborative Innovation Center of Hematology Peking University Beijing China

3. Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China

4. National Clinical Research Center for Hematologic Disease Beijing China

Abstract

AbstractHerpes zoster (HZ) refers to the rash appearing on dermatomes due to varicella zoster virus (VZV) reactivation. The incidence of HZ is significantly higher in allogeneic hematopoietic stem cell transplantation (allo‐HSCT) recipients than in non‐HSCT recipients. Although acyclovir prophylaxis is routinely administered to every allo‐HSCT recipient for 1 year after transplantation, some individuals eventually develop late‐onset HZ after completing prophylaxis. Little information is known about the clinical features of HZ after prophylactic antiviral treatment discontinuation, and an effective predictive model of late‐onset HZ needs to be established. A total of 3366 patients who had received allo‐HSCT from 2012 to 2017 were included in our study, among whom 201 developed HZ after 1 year (late‐onset HZ). We designed a nested case–control study to identify potential predictors of late‐onset HZ. Finally, we established a predictive model using binary logistic regression analysis. Age (p < .001), use of immunosuppressants at +1 year (p < .001), CD4‐CD8 ratio at +1 year (p < .001), certain mental disorders (depression, anxiety, insomnia and adjustment disorder) (p < .001), engraftment time of neutrophils (p < .001), and CD8+ cell count at +30 days (p < .001) were independent predictors of late‐onset HZ. A risk grading system was established based on regression coefficients. Discrimination and calibration analysis indicated that the model had good performance. We also identified several predictive factors of the incidence of HZ‐related complications. This is the first scoring system for predicting the incidence of late‐onset HZ after allo‐HSCT. This model can be applied to identify individuals at high risk of late‐onset HZ in the early period after receiving allo‐HSCT.

Funder

National Key Research and Development Program of China

Publisher

Wiley

Subject

Hematology

Reference44 articles.

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4. Infection with varicella‐zoster virus after marrow transplantation;Locksley RM;J Infect Dis,1985

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