Human herpesvirus-6 encephalitis during hematopoietic stem cell transplantation leads to poor prognosis
Article first published online: 18 JAN 2013
© 2013 John Wiley & Sons A/S
Transplant Infectious Disease
Volume 15, Issue 2, pages 195–201, April 2013
How to Cite
Human herpesvirus-6 encephalitis during hematopoietic stem cell transplantation leads to poor prognosis. Transpl Infect Dis 2013. All rights reserved, , , , .
- Issue published online: 5 APR 2013
- Article first published online: 18 JAN 2013
- Manuscript Accepted: 5 SEP 2012
- Manuscript Revised: 16 AUG 2012
- Manuscript Received: 29 APR 2012
- human herpesvirus-6;
- hematopoietic stem cell transplantation;
Indications for the application of hematopoietic stem cell transplantation (HSCT) from alternative donors have remarkably broadened in scope; however, the incidence of infections that lead to failure of HSCT, such as human herpesvirus-6 (HHV-6) encephalitis, has also increased.
We analyzed risk factors for symptomatic HHV-6 reactivation and the development of HHV-6 encephalitis in 140 consecutive adult patients who received allogeneic HSCT at our institution. Stem cell sources for the recipients were as follows: related-donor bone marrow in 40, related-donor peripheral blood in 5, unrelated bone marrow in 67, and unrelated cord blood in 28.
Symptomatic HHV-6 reactivation occurred in 22 patients (16%), and 11 patients manifested encephalitis. Multivariate Cox proportional hazards regression analysis identified cord blood cell transplantation (CBT) as an independent predictor of HHV-6 reactivation (P = 0.008). Hyponatremia or hypernatremia at the time of HHV-6 reactivation was detected before the development of HHV-6 encephalitis in 2 or 4 patients, respectively. Two patients died of HHV-6 encephalitis and 6 patients died of relapse of underlying diseases. Survival analysis identified higher risk of the disease (P = 0.021) and HHV-6 encephalitis (P = 0.003) as independent risk factors for reduced overall survival.
In cases involving CBT or unrelated-donor transplantation, patients should be carefully monitored for the symptomatic reactivation of HHV-6.