Journal Article

Clinical characteristics and outcome of human herpesvirus-6 encephalitis after allogeneic hematopoietic stem cell transplantation

Ueda, Y, Ichinohe, T, Miyamoto, T, Fukuda, T, Ikebe, T, Kanamori, H, Mori, T, Atsuta, Y, Ueki, T, Eto, T, Ogata, M, Hashimoto, H, Oshima, K, Takano, K, Kondo, T, Ogawa, H

2017

Overview

In this retrospective analysis using the Transplant Registry Unified Management Program, we identified 145 patients with human herpesvirus (HHV)-6 encephalitis among 6593 recipients. The cumulative incidences of HHV-6 encephalitis at 100 days after transplantation in all patients, recipients of bone marrow or PBSCs and recipients of cord blood were 2.3%, 1.6% and 5.0%, respectively. Risk factors identified in multivariate analysis were male sex, type of transplanted cells (relative risk in cord blood transplantation, 11.09, P <0.001; relative risk in transplantation from HLA-mismatched unrelated donor, 9.48, P <0.001; vs transplantation from HLA-matched related donor) and GvHD prophylaxis by calcineurin inhibitor alone. At 100 days after transplantation, the overall survival rate was 58.3% and 80.5% among patients with and without HHV-6 encephalitis, respectively ( P <0.001). Neuropsychological sequelae remained in 57% of 121 evaluated patients. With both foscarnet and ganciclovir, full-dose therapy (foscarnet ⩾180 mg/kg, ganciclovir ⩾10 mg/kg) was associated with better response rate (foscarnet, 93% vs 74%, P =0.044; ganciclovir, 84% vs 58%, P =0.047). HHV-6 encephalitis is not rare not only in cord blood transplant recipients but also in recipients of HLA-mismatched unrelated donors. In this study, development of HHV-6 encephalitis was associated with a poor survival rate, and neurological sequelae remained in many patients.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 692/308/174 / 692/699/255 / 692/699/375 / Adolescent / Antiviral Agents - therapeutic use / Blood / Bone marrow / Bone marrow transplantation / Calcineurin / Calcineurin inhibitors / Care and treatment / Cell Biology / Cord blood / Development and progression / Diagnosis / Disease prevention / Dosage and administration / Encephalitis / Encephalitis, Viral - mortality / Encephalitis, Viral - therapy / Encephalitis, Viral - virology / Foscarnet / Foscarnet - therapeutic use / Ganciclovir / Ganciclovir - therapeutic use / Graft-versus-host reaction / Health risk assessment / Hematology / Hematopoietic stem cell transplantation / Hematopoietic stem cells / Herpesvirus 6, Human - pathogenicity / Histocompatibility antigen HLA / Human herpesvirus 6 / Humans / Internal Medicine / Medicine / Medicine & Public Health / Multivariate analysis / Neurological complications / original-article / Patients / Public Health / Registries / Retrospective Studies / Risk analysis / Risk Factors / Roseolovirus Infections / Stem cell transplantation / Stem Cell Transplantation - adverse effects / Stem Cell Transplantation - methods / Stem Cells / Survival / Survival Analysis / Tissue Donors / Transplantation / Transplantation, Homologous - adverse effects / Transplants & implants