Incidence and Risk of Postherpetic Neuralgia after Varicella Zoster Virus Infection in Hematopoietic Cell Transplantation Recipients: Hokkaido Hematology Study Group

概要

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To assess the incidence of and risk factors associated with post-herpetic neuralgia (PHN) after post-hematopoietic cell transplantation (HCT) varicella-zoster virus (VZV) infection, we conducted a retrospective chart review of 418 consecutive patients who underwent HCT between April 2005 and March 2007. Male/female ratio was 221/197, median age at HCT was 47 years (range: 0-69 years), and autologous/allogeneic/syngeneic HCT ratio was 154/263/1. Seventy-eight patients developed VZV infection after HCT. Sixty-two patients had localized zoster, 11 patients had disseminated zoster (rash like chicken pox), and 4 patients had visceral zoster. All cases were treated with acyclovir (ACV) or valacyclovir (VACV), and there was no VZV infection-related death. Twenty-seven (35%) of the 78 patients with VZV infection suffered PHN after resolution of VZV infection. Multivariate analysis showed that advanced age is the only risk factor in autologous HCT (P = 0.0075; OR = 1.14; 95% Cl, 0.97 to 1.33). On the other hand, advanced age (P = 0.0097; OR = 1.06; 95% Cl, 1.01 to 1.12), male gender (P = 0.0055; OR = 12.7; 95% Cl, 1.61 to 100.1), and GVHD prophylaxis with a tacrolimus-based regimen (P = 0.0092; OR = 9.56; 95% Cl, 1.44 to 63.3) were associated with increased risk of PHN in allogeneic HCT. This study for the first time clarified the risk of PHN in HCT recipients.
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