期刊
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
卷 20, 期 6, 页码 787-793出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2014.02.010
关键词
Cord blood transplantation; Human herpesvirus-6; Cytomegalovirus; HHV-6 encephalitis
资金
- Gabrielle's Angel Foundation for Cancer Research
- MSKCC Society
- Translational and Integrative Medicine Research Grant
- National Cancer Institute, National Institutes of Health [P01 CA23766]
Cord blood transplantation (CBT) is a known risk factor for human herpesvirus-6 (HHV-6) infection. We analyzed the nature of HHV-6 infections in 125 double-unit CBT recipients (median age, 42 years) transplanted for hematologic malignancies with calcineurin inhibitor/mycophenolate mofetil prophylaxis and no antithymocyte globulin. One hundred seventeen patients (94%) reactivated HHV-6 by quantitative plasma PCR (median peak, 7600 copies/mL; range, 100 to 160,000) at a median of 20 days (range, 10 to 59) after transplantation. HHV-6 encephalitis occurred in 2 patients (1.6%), of whom 1 died and 1 recovered with therapy. No association was found between high-level HHV-6 viremia (>= 10,000 or >= 25,000 copies/mL) and age, diagnosis, conditioning intensity, or dominant unit characteristics or between high-level viremia and transplant outcomes (engraftment, cytomegalovirus reactivation, day 100 grades II to IV acute graft-versus-host disease, day 100 transplant-related mortality, or 1-year disease-free survival). HHV-6 therapy delayed the onset of cytomegalovirus reactivation. Interestingly, HHV-6 resolution was observed in untreated patients, and resolution of viremia correlated with absolute lymphocyte count recovery. We observed a low incidence of encephalitis and no association with CBT outcomes. Our data suggest therapy in uncomplicated viremia may not be warranted. However, further investigation of the risk-to-benefit of HHV-6 viremia treatment and standardization of PCR testing is required. (C) 2014 American Society for Blood and Marrow Transplantation.
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