Reactivation of Human Herpes Virus-6 After Pediatric Stem Cell Transplantation. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Verhoeven, Dirk H. J.; Claas, Eric C. J.; Jol-van der Zijde, Cornelia M.; Thijssen, Joyphi C. P.; Lankester, Arjan C.; Bredius, Robbert G. M.; Putter, Hein; Kroes, Aloys C. M.; Egeler, R. Maarten; Schilham, Marco W.; van Tol, Maarten J. D.
• Is Part Of: Pediatric infectious disease journal. Volume 34:Issue 10(2015)
• Publication Date: 2015-10
• Subjects: Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000000824
• Languages: English
• ISSNs: 0891-3668

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background and Methods:</title> <p>To study clinical symptoms, timing and consequences of human herpesvirus-6 (HHV-6) reactivation after pediatric allogeneic stem cell transplantation (SCT), HHV-6 was investigated by plasma polymerase chain reaction in a cohort of 106 pediatric SCT recipients.</p> </sec> <sec> <title>Results:</title> <p>HHV-6 viremia was detected post-SCT in 48% of the patients with a median time of onset at 20 days after SCT. In week 3 and 4 post-SCT, HHV-6 is the most common infectious agent detected. In up to 30% of the patients with fever of unknown origin, HHV-6 was the only detected infectious agent to explain fever. Patients transplanted with an unrelated donor or receiving serotherapy were at increased risk of HHV-6 reactivation. The onset of HHV-6 reactivation coincided with the appearance of lymphocytes and monocytes in peripheral blood. Treatment with alemtuzumab (MabCampath) delayed both lymphocyte and monocyte engraftment and, concomitantly, onset of HHV-6 reactivation was delayed in those cases. HHV-6 reactivation was not associated with an increased incidence of acute graft-versus-host disease (GvHD). However, progression to grade II–IV GvHD was in 9 of 10 patients associated with HHV-6 reactivation before GvHD (<italic>P</italic> = 0.006) and HHV-6 was the only infection with such an association.</p> </sec> <sec> <title>Conclusions:</title> <p>HHV-6 frequently reactivates after pediatric SCT around the time of mononuclear cell engraftment and is associated with an increased severity of GvHD. HHV-6 may explain fever of unknown origin in 30% of the patients early after SCT. Assessment of HHV-6 reactivation in patients early after SCT can be instrumental for clinical decision making.</p> </sec> </abstract>