Frequent human herpesvirus-6 viremia but low incidence of encephalitis in double-unit cord blood recipients transplanted without antithymocyte globulin Journal Article
| Authors: | Olson, A. L.; Dahi, P. B.; Zheng, J.; Devlin, S. M.; Lubin, M.; Gonzales, A. M.; Giralt, S. A.; Perales, M. A.; Papadopoulos, E. B.; Ponce, D. M.; Young, J. W.; Kernan, N. A.; Scaradavou, A.; O'Reilly, R. J.; Small, T. N.; Papanicolaou, G.; Barker, J. N. |
| Article Title: | Frequent human herpesvirus-6 viremia but low incidence of encephalitis in double-unit cord blood recipients transplanted without antithymocyte globulin |
| Abstract: | 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. © 2014 American Society for Blood and Marrow Transplantation. |
| Keywords: | cytomegalovirus; cord blood transplantation; hhv-6 encephalitis; human herpesvirus-6 |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 20 |
| Issue: | 6 |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2014-06-01 |
| Start Page: | 787 |
| End Page: | 793 |
| Language: | English |
| DOI: | 10.1016/j.bbmt.2014.02.010 |
| PROVIDER: | scopus |
| PUBMED: | 24548875 |
| PMCID: | PMC4097025 |
| DOI/URL: | |
| Notes: | Biol. Blood Marrow Transplant. -- Export Date: 2 June 2014 -- CODEN: BBMTF -- Source: Scopus |
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