Groenveld, L.M. (2025) Increased Risk of VZV Reactivation Using Relatively Short Acyclovir Prophylaxis After Pediatrie Allogeneic Hematopoietic Cell Transplantation. thesis, Medicine.
Full text available on request.Abstract
Background: Varicella-zoster virus (VZV) reactivation is a serious complication in pediatric patients undergoing allogeneic hematopoietic cell transplantation (HCT), secondary to delayed immune reconstitution, often contributing to post-transplant morbidity. While one year of (val)acyclovir prophylaxis is recommended post-HCT, the optimal duration in pediatric patients needs to be established. This study evaluated the incidence of VZV reactivation and associated risk factors in a center where prophylaxis is routinely discontinued by 6 months, based on immune reconstitution. Methods: This single-center retrospective study included children aged ≤18 years who underwent allogeneic HCT between January 2020 and January 2023, receiving a shorter duration of (val)acyclovir prophylaxis than recommended. Results: A total of 117 pediatric HCT recipients were included in this study. The median follow-up was 478 (range: 54-1810) days, with (val)acyclovir prophylaxis administered for a median of 196 (range: 37-694) days post-HCT. VZV reactivation occurred in 54.7% (n=64) at a median of 248 (range: 54-1033) days post-HCT. The peak incidence occurred between 6 and 12 months post-HCT, primarily after cessation of prophylaxis (95.3%). 25% (n=16) of the VZV-infected patients were hospitalized, 25% developed herpes zoster ophthalmicus, and 39.1% had postherpetic neuralgia. The CD4+ T-cell count at cessation of prophylaxis was not associated with reactivation risk. In multivariate analysis, short-term prophylaxis was an independent risk factor for VZV reactivation (HR 2.20; 95% CI: 1.30-3.72; p= 0.003). Conclusion: VZV reactivation frequently occurs after cessation of (val)acyclovir prophylaxis. This study supports extending prophylaxis to at least one year, as immune reconstitution alone appears insufficient to prevent VZV reactivation.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Legger, G.E. and Lindemans, C. |
| Faculty: | Medical Sciences |
| Date Deposited: | 24 Feb 2026 14:27 |
| Last Modified: | 24 Feb 2026 14:27 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3898 |
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