Variable Clinical Courses of Varicella Zoster Virus Infection-related or Vaccination-related Bone Marrow Failure

Vasil Toskov; Annamaria Cseh; Alexander Claviez; Beatrice Drexler; Natalia Rotari; Stephan Schwarz-Furlan; Matthias Braun; Peter Bader; Peter Lang; Rita Beier; Bernhard Erdlenbruch; Monika Führer; Miriam Erlacher; Charlotte M Niemeyer; Brigitte Strahm; Ayami Yoshimi

doi:10.1097/MPH.0000000000002866

Variable Clinical Courses of Varicella Zoster Virus Infection-related or Vaccination-related Bone Marrow Failure

J Pediatr Hematol Oncol. 2024 Apr 23. doi: 10.1097/MPH.0000000000002866. Online ahead of print.

Authors

Vasil Toskov¹, Annamaria Cseh^{1

2}, Alexander Claviez³, Beatrice Drexler^{1

4}, Natalia Rotari¹, Stephan Schwarz-Furlan^{5

6}, Matthias Braun⁷, Peter Bader⁸, Peter Lang⁹, Rita Beier¹⁰, Bernhard Erdlenbruch¹¹, Monika Führer¹², Miriam Erlacher¹, Charlotte M Niemeyer¹, Brigitte Strahm¹, Ayami Yoshimi¹

Affiliations

¹ Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg.
² Department of Stem Cell Transplantation, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria.
³ Department of Pediatrics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel.
⁴ Department of Medicine, Division of Hematology, University Hospital Basel, Basel, Switzerland.
⁵ Institute of Pathology, Klinikum Kaufbeuren-Ravensburg, Kaufbeuren.
⁶ Institute of Pathology, University Hospital Erlangen, Erlangen.
⁷ Department of Padiatrische Hamatologie und Onkologie, Zentrum fur Kinderheiikunde der Justus-Liebig-Universitat Giessen, Giessen.
⁸ Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main.
⁹ Department of Hematology/Oncology and General Pediatrics, Children's University Hospital, University of Tübingen, Tübingen.
¹⁰ Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover.
¹¹ Department of Pediatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden.
¹² Center for Pediatric Palliative Care, Dr von Hauner Children's Hospital, University of Munich, Munich, Germany.

PMID: 38652069
DOI: 10.1097/MPH.0000000000002866

Abstract

We report 5 children with bone marrow failure (BMF) after primary varicella zoster virus (VZV) infection or VZV vaccination, highlighting the highly variable course. Two patients were treated with intravenous immunoglobulins; one had a slow hematologic recovery, and the other was rescued by allogeneic hematopoietic stem cell transplantation (HSCT). Of the 2 patients treated with immunosuppressive therapy with antithymocyte globulin and cyclosporine, one had a complete response, and the other was transplanted for nonresponse. One patient underwent a primary allograft. All patients are alive. This study demonstrated that VZV-associated BMF is a life-threatening disorder that often requires HSCT.