Human herpesvirus-6B reactivation Is a risk factor for grades II to IV acute graft-versus-host disease after hematopoietic stem cell transplantation: A systematic review and meta-analysis Journal Article


Authors: Phan, T. L.; Carlin, K.; Ljungman, P.; Politikos, I.; Boussiotis, V.; Boeckh, M.; Shaffer, M. L.; Zerr, D. M.
Article Title: Human herpesvirus-6B reactivation Is a risk factor for grades II to IV acute graft-versus-host disease after hematopoietic stem cell transplantation: A systematic review and meta-analysis
Abstract: Graft-versus-host disease (GVHD) is an important cause of morbidity and mortality after allogeneic hematopoietic cell transplantation (HCT). Many studies have suggested that human herpesvirus-6B (HHV-6B) plays a role in acute GVHD (aGVHD) after HCT. Our objective was to systematically summarize and analyze evidence regarding HHV-6B reactivation and development of aGVHD. PubMed and EMBASE databases were searched using terms for HHV-6, HCT, and aGVHD, yielding 865 unique results. Case reports, reviews, articles focusing on inherited chromosomally integrated HHV-6, poster presentations, and articles not published in English were excluded. The remaining 467 articles were reviewed for the following requirements: a statistical analysis of HHV-6B reactivation and aGVHD was described, HHV-6B reactivation was defined by PCR, and blood (plasma, serum, or peripheral blood mononuclear cells) was used for HHV-6B PCR. Data were abstracted from publications that met these criteria (n = 33). Publications were assigned to 1 of 3 groups: (1) HHV-6B reactivation was analyzed as a time-dependent risk factor for subsequent aGVHD (n = 14), (2) aGVHD was analyzed as a time-dependent risk factor for subsequent HHV-6B reactivation (n = 1), and (3) analysis without temporal specification (n = 18). A statistically significant association (P <.05) between HHV-6B reactivation and aGVHD was observed in 10 of 14 studies (71%) in group 1, 0 of 1 study (0%) in Group 2, and 8 of 18 studies (44.4%) in Group 3. Of the 14 studies that analyzed HHV-6B as a risk factor for subsequent aGVHD, 11 performed a multivariate analysis and reported a hazard ratio, which reached statistical significance in 9 of these studies. Meta-analysis of these 11 studies demonstrated a statistically significant association between HHV-6B and subsequent grades II to IV aGVHD (hazard ratio, 2.65; 95% confidence interval, 1.89 to 3.72; P <.001). HHV-6B reactivation is associated with aGVHD, and when studies have a temporal component to their design, HHV-6B reactivation is associated with subsequent aGVHD. Further research is needed to investigate whether antiviral prophylaxis reduces incidence or severity of aGVHD. © 2018 The American Society for Blood and Marrow Transplantation
Keywords: risk factor; graft-versus-host disease; human herpesvirus-6
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 24
Issue: 11
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2018-11-01
Start Page: 2324
End Page: 2336
Language: English
DOI: 10.1016/j.bbmt.2018.04.021
PUBMED: 29684567
PROVIDER: scopus
PMCID: PMC8934525
DOI/URL:
Notes: Review -- Export Date: 3 December 2018 -- Source: Scopus
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