Characterizing human herpes virus 6 following hematopoietic stem cell transplantation

J Oncol Pharm Pract. 2015 Apr;21(2):85-92. doi: 10.1177/1078155213519837. Epub 2014 Jan 9.

Abstract

Background: Human herpes virus 6 reactivation occurs in approximately 50% of patients following hematopoietic stem cell transplant, however, the significance of human herpes virus 6 reactivation remains uncertain.

Methods: A retrospective study was conducted analyzing clinical data of patients testing positive for human herpes virus 6 by quantitative polymerase chain reaction following hematopoietic stem cell transplant from 1 January 1998 to 1 October 2011. Data retrieved were used to describe the clinical course and outcome of human herpes virus 6 positive hematopoietic stem cell transplant patients.

Results: Sixty patients were identified who tested positive for human herpes virus 6 by polymerase chain reaction following hematopoietic stem cell transplant. A high proportion of patients were identified in this cohort with acute myeloid leukemia (28.3%), active disease (65%), transplanted with a matched unrelated donor (30%), ≥ 1 antigen mismatched (28.3%) matched unrelated donor, or an umbilical cord graft (25%), and those who received antithymocyte globulin (42.4%). Thirty-eight (63.3%) patients were treated for human herpes virus 6 with foscarnet alone or in combination with intravenous immunoglobulin, whereas 18 (30%) did not require treatment survival at Day 100 was 73.3%.

Conclusion: This study suggests human herpes virus 6 reactivation occurs shortly after hematopoietic stem cell transplant (median of 25 days (interquartile range, 20-31.75) after hematopoietic stem cell transplant). Many potential risk factors are described in this report. Treatment of human herpes virus 6 predominately consisted of foscarnet with or without intravenous immunoglobulin; however, treatment of human herpes virus 6 was not always warranted. Furthermore, the effect of treatment on patient outcomes is uncertain.

Keywords: Human herpes virus 6; hematopoietic stem cell transplantation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antiviral Agents / therapeutic use
  • Child
  • Child, Preschool
  • DNA, Viral / genetics
  • Drug Therapy, Combination
  • Female
  • Foscarnet / therapeutic use
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Herpesvirus 6, Human / genetics
  • Herpesvirus 6, Human / physiology*
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use
  • Leukemia, Myeloid, Acute / diagnosis
  • Leukemia, Myeloid, Acute / surgery*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Roseolovirus Infections / diagnosis
  • Roseolovirus Infections / drug therapy
  • Roseolovirus Infections / virology*
  • Time Factors
  • Treatment Outcome
  • Viral Load
  • Virus Activation*
  • Young Adult

Substances

  • Antiviral Agents
  • DNA, Viral
  • Immunoglobulins, Intravenous
  • Foscarnet