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Post-Transplant Events

Herpes zoster infection in the post-hematopoietic stem cell transplant pediatric population may be preceded by transaminitis: an institutional experience

Bone Marrow Transplantation volume 37, pages 73–80 (2006)Cite this article

Abstract

Herpes zoster (HZ), a varicella-zoster virus reactivation, frequently complicates hematopoietic stem cell transplantation (HSCT). Its incidence, complications, and associated risk factors in 310 children undergoing HSCT were reviewed. In all, 61 of 201(32%) patients who had undergone allogeneic and 10 of 109 (9%) patients who had undergone autologous HSCT developed HZ. Of 90 VZV seropositive allogeneic patients, 50 (53%) developed HZ. Seven (17%) of 41 VZV seropositive autologous patients developed HZ. Although a substantial number of patients develop HZ in the early post-HSCT period, risk for HZ persists and HZ can occur up to 5 years post-HSCT. Risk factors for HZ included age >10 years (P<0.0001), allogeneic HSCT (P<0.001), and total body irradiation (TBI) (P<0.059) in allogeneic recipients. Of 37, 22 (59%) patients experienced an elevated alanine aminotransferase (ALT), unassociated with GVHD, in the month preceding HZ. Of the 48/64 patients (75%) hospitalized for treatment (median stay, 6 days; range, 2–39), length of stay was unaffected by donor type but increased by cutaneous dissemination and visceral involvement (P=0.023 and 0.034, respectively) in allogeneic patients. Consideration of HZ infection particularly in patients >10 years of age with elevated ALT after TBI-conditioned allogeneic HSCT may permit earlier diagnosis and therapeutic intervention.

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Acknowledgements

We thank Andrew Bradnan and David Rogers for database management support. We also thank Lisa Brennan for helpful suggestions on this manuscript, and Valerie Russo for administrative assistance. Finally, we thank physician and nursing staffs of 6W and the Jimmy Fund Clinic for their expert patient care and the research staff of the Pediatric Transplant Program for all of their able assistance. Research Grants and Financial Support: Jason Berman, MD, is a St. Jude Children's Research Hospital Fellow of the Pediatric Scientist Development Program (NICHD Grant Award K12-HD00850). This research is also funded by the Frank J Hanna Jr. Fund and NIH PO1 CA100265.

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Authors and Affiliations

  1. Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    J N Berman, W Berry & E C Guinan

  2. Department of Pediatric Hematology/Oncology, Children's Hospital, Boston, MA, USA

    J N Berman & E C Guinan

  3. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

    M Wang & D S Neuberg

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  1. J N Berman
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Correspondence to E C Guinan.

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Berman, J., Wang, M., Berry, W. et al. Herpes zoster infection in the post-hematopoietic stem cell transplant pediatric population may be preceded by transaminitis: an institutional experience. Bone Marrow Transplant 37, 73–80 (2006). https://doi.org/10.1038/sj.bmt.1705191

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