A predictive model of varicella-zoster virus infection after autologous peripheral blood progenitor cell transplantation

Varicella-zoster virus (VZV) frequently causes severe infections in patient s who have undergone bone marrow transplantation. The frequency of, charact eristics of, and risk factors for this infection were studied in 164 patien ts undergoing autologous peripheral blood progenitor cell transplantation ( PBPCT). Twenty-six patients (15.8%) developed VZV infection, and the actuar ial risk was 10% at 1 year. No patient had visceral dissemination or died b ecause of VZV, although one-third of the patients developed postherpetic ne uralgia. By multivariate analysis, a CD4(+) lymphocyte count of <200 cells/ <mu>L (P < .0001; odds ratio [OR], 2.0) and a CD8(+) lymphocyte count of <8 00 cells/muL (P = .0073; OR, 2.0) at day 30 after transplantation were fact ors associated with VZV infection. Patients with both these adverse factors had an actuarial risk of VZV of 48% at 1 year. Patients with deficiency in both CD4(+) and CD8(+) lymphocytes are at high risk of VZV infection. Thes e patients should be considered as candidates for preventive therapy, but w hether for antiviral therapy or vaccination remains to be investigated.