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
Altmetric
Citation Impact
MSK Authors
  1. Junting Zheng
    149 Zheng
  2. Nancy Kernan
    435 Kernan
  3. Trudy Small
    215 Small
  4. Sergio Andres Giralt
    613 Giralt
  5. Amanda Leigh Olson
    12 Olson
  6. Doris Ponce
    149 Ponce
  7. Miguel-Angel Perales
    455 Perales
  8. Juliet N Barker
    251 Barker
  9. James W Young
    279 Young
  10. Richard O'Reilly
    580 O'Reilly
  11. Marissa N Lubin
    78 Lubin
  12. Sean McCarthy Devlin
    353 Devlin
  13. Parastoo Bahrami Dahi
    124 Dahi