Clinical characteristics and outcome of human herpesvirus-6 encephalitis after allogeneic hematopoietic stem cell transplantation

Abstract

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 o0.001; relative risk in transplantation from HLA-mismatched unrelated donor, 9.48, P o0.001; 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 o 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.

HHV‐6 in liver transplantation: A literature review

“…HHV-6 encephalitis is most often seen in cord blood (8%-10%) and stem cell transplant patients (1%-3%), [33][34][35] but it has also been reported in several liver transplant recipients. A retrospective review of medical and laboratory records reported a correlation between HHV-6 infection and symptoms of encephalitis in seven (35%) of 20 liver transplant patients.…”

Make Sure You Have a Safety Net: Updates in the Prevention and Management of Infectious Complications in Stem Cell Transplant Recipients

“…Foscarnet, ganciclovir and cidofovir have activity against HHV-6B [159], but foscarnet and ganciclovir are considered first-line given that cidofovir is highly nephrotoxic. Full-dose foscarnet or ganciclovir are more effective than lower dose therapy [181]. For patients with normal renal function, foscarnet 60 mg/kg IV every 8 h or 90 mg/kg IV every 12 h or ganciclovir 5 mg/kg IV every 12 h should be given [182][183][184].…”

Correlations of cytokine levels in cerebrospinal fluid and peripheral blood with outcome of HHV‐6B encephalitis after hematopoietic stem cell transplantation

“…Reactivation of HHV‐6B occurs in 30% to 70% of recipients after allogeneic hematopoietic cell transplantation (allo‐HCT) . HHV‐6B encephalitis has been recognized as a serious complication caused by reactivated HHV‐6B.…”