Although acyclovir prophylaxis against varicella zoster virus (VZV) infection for ≥1 year is recommended after allogeneic hematopoietic cell transplantation (HCT), the emergence of acyclovir-resistant viruses and adverse drug effects cannot be ignored. We investigated the cumulative incidence of VZV infection after allogeneic HCT in children receiving a shorter duration of acyclovir prophylaxis than recommended and evaluated the appropriateness of the short duration of acyclovir prophylaxis.Medical records of 217 children who received allogeneic HCT were retrospectively reviewed until a median of 25 months (range = 1-59 months) after HCT. Acyclovir prophylaxis was given for a median of 9 weeks (range = 3-24 weeks) after HCT.VZV infection was diagnosed in 33 (15.2%) children at a median time of 5 months (range = 2-41 months) after HCT. The 1-year and 2-year cumulative incidences of VZV infection after allogeneic HCT were 11.2% and 15.5%, respectively. These incidences were between the previously reported 1-year incidence of 25% to 30% in patients not receiving prophylaxis and 1-year incidence of 4% to 5% in patients receiving ≥1 year duration of prophylaxis. Male sex and older age were significantly associated with VZV infection after allogeneic HCT. Only 1 chickenpox patient experienced severe complications because of VZV infection, and there were no deaths attributable to VZV infection.In conclusion, a shorter duration of acyclovir prophylaxis may be appropriate for children receiving allogeneic HCT, based on the rare occurrence of severe complications because of VZV infection and the expected discomfort because of daily oral medication for a long time.

译文

尽管异基因造血细胞移植 (HCT) 后建议使用阿昔洛韦预防水痘带状疱疹病毒 (VZV) 感染 ≥ 1年,但阿昔洛韦耐药病毒的出现和药物不良反应不容忽视。我们调查了接受阿昔洛韦预防时间比推荐时间短的儿童在异基因HCT后VZV感染的累积发生率,并评估了阿昔洛韦预防时间短的适当性。回顾性回顾了接受异基因HCT的217名儿童的病历,直到中位数为25个月 (范围   = 1-59个月)) 在HCT之后。在HCT后的中位时间为9周 (范围   =   3-24周) 给予阿昔洛韦预防治疗。在HCT后的中位时间为5个月 (范围   =   2-41个月) 的33 (15.2%) 名儿童中诊断出VZV感染。异基因HCT后VZV感染的1年和2年累积发生率分别为11.2% 和15.5%。这些发生率介于先前报道的未接受预防的患者1年25% 至30% 的发生率和接受 ≥ 1年预防持续时间的患者1年4% 至5% 的发生率之间。同种异体HCT后,男性和年龄较大与VZV感染显着相关。只有1名水痘患者因VZV感染而出现严重并发症,并且没有因VZV感染而导致的死亡。总之,较短的阿昔洛韦预防时间可能适合接受同种异体HCT的儿童。基于因VZV感染而罕见的严重并发症的发生,以及因长期每日口服药物而预期的不适。

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