Preemptive therapy of human herpesvirus-6 encephalitis with foscarnet sodium for high-risk patients after hematopoietic SCT.

Abstract

Human herpesvirus-6 (HHV-6) is a major cause of limbic encephalitis with a dismal prognosis after allogeneic hematopoietic SCT (HSCT). A prospective, multicenter study was conducted to assess the safety and efficacy of preemptive therapy with foscarnet sodium (PFA) for the prevention of HHV-6 encephalitis. Plasma HHV-6 DNA was measured thrice weekly from day 7 until day 36 after umbilical cord blood transplantation (UCBT) or HSCT from HLA-haploidentical relatives. PFA, 90 mg/kg/day, was started when HHV-6 DNA exceeded 5 × 10(2) copies/mL. Mild and transient adverse events were associated with PFA in 7 of 8 patients. Twelve of 15 UCBT recipients became positive for HHV-6 DNAemia, defined by greater than 1 × 10(2) copies/mL of HHV-6 DNA in plasma. The virus exceeded 5 × 10(2) copies/mL in seven patients, whereas none of the five HLA-haploidentical HSCT recipients became positive. One patient developed mild limbic encephalitis just after initial PFA administration. Preemptive PFA therapy is safe, but as HHV-6 DNAemia can abruptly develop before neutrophil engraftment in UCBT recipients, prophylactic PFA administration from day 7 or earlier after UCBT may be needed.

• Authors: K Ishiyama, T Katagiri, T Hoshino, T Yoshida, M Yamaguchi, S Nakao
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 46 Issue 6 Pg. 863-9 (Jun 2011) ISSN: 1476-5365 [Electronic] England
• PMID: 20838386 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• DNA, Viral
• Foscarnet

Topics

• Adolescent
• Adult
• Chemoprevention (methods)
• DNA, Viral (blood)
• Encephalitis (etiology, prevention & control, virology)
• Female
• Foscarnet (therapeutic use)
• Hematopoietic Stem Cell Transplantation (adverse effects, methods)
• Herpesvirus 6, Human (isolation & purification)
• Humans
• Male
• Middle Aged
• Premedication (methods)
• Roseolovirus Infections (prevention & control)
• Treatment Outcome
• Young Adult