期刊
BONE MARROW TRANSPLANTATION
卷 52, 期 11, 页码 1563-1570出版社
NATURE PUBLISHING GROUP
DOI: 10.1038/bmt.2017.175
关键词
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资金
- Practical Research Project for Allergic Diseases and Immunology from the Japan Agency for Medical Research and Development, AMED
- Research Program on Practical Research for Innovative Cancer Control from AMED
- Grants-in-Aid for Scientific Research [16H05340, 17K09090] Funding Source: KAKEN
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.
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