Clinical outcomes of human herpesvirus 6 reactivation after hematopoietic stem cell transplantation.

Abstract

BACKGROUND:

Although human herpesvirus 6 (HHV-6) is known to reactivate during hematopoietic stem cell transplantation (HSCT), the clinical significance of this finding is controversial.

METHODS:

We used a quantitative PCR test for HHV-6 to assay plasma samples prospectively collected from a cohort of 110 allogeneic HSCT recipients to evaluate the clinical effects of HHV-6 infection. A retrospective review of medical records was performed to determine clinical end points.

RESULTS:

HHV-6 reactivation occurred in 52 (47%) of the 110 subjects. Factors that increased the risk of subsequent HHV-6 reactivation were hematologic malignancy that occurred at a time other than the first remission (adjusted P = .002), a mismatch in the sexes of donor and recipient (adjusted P=.05), younger age (adjusted P = .01), and the receipt of glucocorticoids (adjusted P = .06). HHV-6 reactivation was associated with subsequent all-cause mortality (adjusted hazard ration [HR], 2.9; 95% confidence interval [CI], 1.1-7.5), grade 3-4 graft-versus-host disease (GVHD) (adjusted HR, 4.9; 95% CI, 1.5-16), a lower probability of monocyte engraftment (adjusted HR, 0.42; 95% CI; 0.22-0.80), a lower probability of platelet engraftment (adjusted HR, 0.47; 95% CI, 0.21-1.1; P = .05) and a higher platelet transfusion requirement (adjusted P = .02). A higher level of HHV-6 DNA was associated with subsequent central nervous system (CNS) dysfunction (HR, 21; 95% CI, 1.8-249).

CONCLUSIONS:

HHV-6 reactivation is common after allogeneic HSCT and is associated with subsequent delayed monocyte and platelet engraftment, increased platelet transfusion requirements, all-cause mortality, grade 3-4 GVHD, and CNS dysfunction.

• Authors: Danielle M Zerr, Lawrence Corey, Hyung W Kim, Meei-Li Huang, Long Nguy, Michael Boeckh
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 40 Issue 7 Pg. 932-40 (Apr 01 2005) ISSN: 1537-6591 [Electronic] United States
• PMID: 15824982 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• DNA, Viral

Topics

• Adolescent
• Adult
• Aged
• Cohort Studies
• DNA, Viral (blood)
• Female
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Herpesvirus 6, Human (isolation & purification)
• Humans
• Male
• Middle Aged
• Platelet Transfusion
• Risk Factors
• Roseolovirus Infections (etiology, virology)
• Time Factors
• Virus Activation