Human herpesvirus 6 infection after autologous stem cell transplantation: A multicenter prospective study in adult patients

Abstract

Objectives: to prospectively evaluate the incidence and the clinical relevance on hematopoietic reconstitution of HHV-6 infection in autologous hematopoietic stem cell transplantation (ASCT) recipients.Methods: HHV-6 DNA load was measured in whole blood specimens once during the 7 days before stem cell re-infusion and once a week after transplantation until hematopoietic recovery. Active HHV-6 infection was defined by 2 consecutive positive DNA loads.Results: from July 2012 to February 2015, 196 adult patients undergoing ASCT were enrolled. Twenty-two (11.2%) patients developed active HHV-6 infection with a cumulative incidence of 19% at 40 days after transplantation. The onset of active HHV-6 infection occurred with a median of 13 days after stem cell re-infusion. HHV-6 infection was associated with an increased frequency of non-infectious complications (OR = 5.05; 95%CI 1.78-14.32; P<.001). Moreover, the severity of these non-infectious complications was higher in recipients exhibiting HHV-6 infection (OR = 4.62; 95%CI 1.32-16.2; p<.01). Delayed neutrophils 10 (IQR: 8-14) vs 8 (IQR: 6-11) days and platelets recoveries 15 (IQR: 11.8-18.5) vs 8 (IQR: 4-14) days were observed in patients with active HHV-6 infection compared to non-infected ones.Conclusions: in this study, 11.2% ASCT recipients presented active HHV-6 infection associated with significantly delayed hematologic reconstitution. Words: 199 Highlights:-Active HHV-6 infection occurred in 11.2% of autologous stem cell recipients -HHV-6 infection is associated to increased frequency of non-infectious complications

High incidence rate of human herpesvirus 6 infection after Bendamustine, Cytarabine, Etoposide and Melphalan conditioning regimen: A monocentric and retrospective study

“…Finally, we observed prolonged hospitalization duration in the BeEAM group. The length of hospitalization and the differences between both regimens found here are similar to what is reported in the literature [31][32][33][34][35][36][37]. This could be explained by the severity of complications (particularly hematological toxicity with delayed ANC and platelets recoveries) together with the need for HHV-6 infection treatment.…”

“…Like other herpsesviruses, HHV-6 has a life-long latency in many organs with a strong tropism for hematopoietic CD34+ progenitor cells in particular. HHV-6 reactivation occurs more commonly in immunocompromised hosts like allogeneic hematopoietic stem cell transplant recipients [35]. A recently published data evaluated prospectively the incidence of HHV-6 infection in patients undergoing ASCT [36].…”

Prophylaxis, diagnosis and therapy of infections in patients undergoing high-dose chemotherapy and autologous haematopoietic stem cell transplantation. 2020 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

“…Human herpes virus 6 (HHV-6) and Epstein-Barr virus (EBV) infections are infrequent after HDC/ASCT and routine prophylaxis is not recommended [ 75 , 76 ]. However, EBV reactivation has been reported at a high frequency in patients with multiple sclerosis undergoing ASCT [ 77 ].…”

Human Herpes Virus-6 Encephalitis Following Autologous Blood and Marrow Transplant

“…However, the incidence of viral reactivation has been shown to be comparable to that in allogeneic BMT recipients in a number of studies [14][15][16][17]. A recent prospective study published by Balsat et al showed a cumulative incidence of HHV-6 reactivation rate of 19% by day +40 following autologous BMT [18].…”

“…A recent prospective study published by Balsat et al . showed a cumulative incidence of HHV-6 reactivation rate of 19% by day +40 following autologous BMT [ 18 ].…”