کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
5524321 | 1546247 | 2016 | 6 صفحه PDF | دانلود رایگان |
- This work is a retrospective analysis of 54 adult patients, positive for human herpesvirus 6 (HHV-6) after allogeneic stem cell transplantation.
- Viral encephalitis was reported for 10 patients.
- Mortality rate was relatively high in this population (1-year overall survival [OS], 38%).
- Better OS was associated with CD3+âcell countââ¥200/µL at the time of HHV-6 reactivation.
- Prospective studies with characterization of HHV-6 immune responses are warranted.
Human herpesvirus 6 (HHV-6) is increasingly recognized as a potentially life-threatening pathogen in allogeneic hematopoietic stem cell transplantation (alloSCT). We retrospectively evaluated 54 adult patients who developed positivity to HHV-6 after alloSCT. The median time from alloSCT to HHV-6 reactivation was 34 days. HHV-6 was present in plasma samples from 31 patients, in bone marrow (BM) of 9 patients, in bronchoalveolar lavage fluid and liver or gut biopsy specimens from 33 patients, and in cerebrospinal fluid of 7 patients. Twenty-nine patients developed acute graft-versus-host disease (GVHD), mainly grade III-IV, and 15 had concomitant cytomegalovirus reactivation. The median absolute CD3+âlymphocyte count was 207 cells/µL. We reported the following clinical manifestations: fever in 43 patients, skin rash in 22, hepatitis in 19, diarrhea in 24, encephalitis in 10, BM suppression in 18, and delayed engraftment in 11. Antiviral pharmacologic treatment was administered to 37 patients; nonetheless, the mortality rate was relatively high in this population (overall survival [OS] at 1 year, 38%â±â7%). A better OS was significantly associated with a CD3+âcell countââ¥200/µL at the time of HHV-6 reactivation (Pâ=â.0002). OS was also positively affected by the absence of acute GVHD grade III-IV (Pâ=â.03) and by complete disease remission (Pâ=â.03), but was not significantly influenced by steroid administration, time after alloSCT, type of antiviral prophylaxis, plasma viral load, or organ involvement. Although HHV-6 detection typically occurred early after alloSCT, better T cell immune reconstitution seems to have the potential to improve clinical outcomes. Our findings provide new insight into the interplay between HHV-6 and the transplanted immune system.
Journal: Biology of Blood and Marrow Transplantation - Volume 22, Issue 12, December 2016, Pages 2250-2255