Clinical characteristics and outcome of human herpesvirus-6 encephalitis after allogeneic hematopoietic stem cell transplantation

M. Ogata, K. Oshima, T. Ikebe, K. Takano, H. Kanamori, T. Kondo, Y. Ueda, Takehiko Mori, H. Hashimoto, H. Ogawa, T. Eto, T. Ueki, T. Miyamoto, T. Ichinohe, Y. Atsuta

Research output: Contribution to journalArticle

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Abstract

In this retrospective analysis using the Transplant Registry Unified Management Program, we identified 145 patients with human herpesvirus (HHV)-6 encephalitis among 6593 recipients. The cumulative incidences of HHV-6 encephalitis at 100 days after transplantation in all patients, recipients of bone marrow or PBSCs and recipients of cord blood were 2.3%, 1.6% and 5.0%, respectively. Risk factors identified in multivariate analysis were male sex, type of transplanted cells (relative risk in cord blood transplantation, 11.09, Po0.001; relative risk in transplantation from HLA-mismatched unrelated donor, 9.48, Po0.001; vs transplantation from HLA-matched related donor) and GvHD prophylaxis by calcineurin inhibitor alone. At 100 days after transplantation, the overall survival rate was 58.3% and 80.5% among patients with and without HHV-6 encephalitis, respectively (Po0.001). Neuropsychological sequelae remained in 57% of 121 evaluated patients. With both foscarnet and ganciclovir, full-dose therapy (foscarnet ?180 mg/kg, ganciclovir ?10 mg/kg) was associated with better response rate (foscarnet, 93% vs 74%, P = 0.044; ganciclovir, 84% vs 58%, P = 0.047). HHV-6 encephalitis is not rare not only in cord blood transplant recipients but also in recipients of HLA-mismatched unrelated donors. In this study, development of HHV-6 encephalitis was associated with a poor survival rate, and neurological sequelae remained in many patients.

Original languageEnglish
Pages (from-to)1563-1570
Number of pages8
JournalBone Marrow Transplantation
Volume52
Issue number11
DOIs
Publication statusPublished - 2017 Nov 1

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Hematopoietic Stem Cell Transplantation
Foscarnet
Transplantation
Ganciclovir
Fetal Blood
Unrelated Donors
Survival Rate
Registries
Multivariate Analysis
Bone Marrow
Human Herpesvirus 6 encephalitis
Tissue Donors
Transplants
Incidence

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Clinical characteristics and outcome of human herpesvirus-6 encephalitis after allogeneic hematopoietic stem cell transplantation. / Ogata, M.; Oshima, K.; Ikebe, T.; Takano, K.; Kanamori, H.; Kondo, T.; Ueda, Y.; Mori, Takehiko; Hashimoto, H.; Ogawa, H.; Eto, T.; Ueki, T.; Miyamoto, T.; Ichinohe, T.; Atsuta, Y.

In: Bone Marrow Transplantation, Vol. 52, No. 11, 01.11.2017, p. 1563-1570.

Research output: Contribution to journalArticle

Ogata, M, Oshima, K, Ikebe, T, Takano, K, Kanamori, H, Kondo, T, Ueda, Y, Mori, T, Hashimoto, H, Ogawa, H, Eto, T, Ueki, T, Miyamoto, T, Ichinohe, T & Atsuta, Y 2017, 'Clinical characteristics and outcome of human herpesvirus-6 encephalitis after allogeneic hematopoietic stem cell transplantation', Bone Marrow Transplantation, vol. 52, no. 11, pp. 1563-1570. https://doi.org/10.1038/bmt.2017.175
Ogata, M. ; Oshima, K. ; Ikebe, T. ; Takano, K. ; Kanamori, H. ; Kondo, T. ; Ueda, Y. ; Mori, Takehiko ; Hashimoto, H. ; Ogawa, H. ; Eto, T. ; Ueki, T. ; Miyamoto, T. ; Ichinohe, T. ; Atsuta, Y. / Clinical characteristics and outcome of human herpesvirus-6 encephalitis after allogeneic hematopoietic stem cell transplantation. In: Bone Marrow Transplantation. 2017 ; Vol. 52, No. 11. pp. 1563-1570.
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abstract = "In this retrospective analysis using the Transplant Registry Unified Management Program, we identified 145 patients with human herpesvirus (HHV)-6 encephalitis among 6593 recipients. The cumulative incidences of HHV-6 encephalitis at 100 days after transplantation in all patients, recipients of bone marrow or PBSCs and recipients of cord blood were 2.3{\%}, 1.6{\%} and 5.0{\%}, respectively. Risk factors identified in multivariate analysis were male sex, type of transplanted cells (relative risk in cord blood transplantation, 11.09, Po0.001; relative risk in transplantation from HLA-mismatched unrelated donor, 9.48, Po0.001; vs transplantation from HLA-matched related donor) and GvHD prophylaxis by calcineurin inhibitor alone. At 100 days after transplantation, the overall survival rate was 58.3{\%} and 80.5{\%} among patients with and without HHV-6 encephalitis, respectively (Po0.001). Neuropsychological sequelae remained in 57{\%} of 121 evaluated patients. With both foscarnet and ganciclovir, full-dose therapy (foscarnet ?180 mg/kg, ganciclovir ?10 mg/kg) was associated with better response rate (foscarnet, 93{\%} vs 74{\%}, P = 0.044; ganciclovir, 84{\%} vs 58{\%}, P = 0.047). HHV-6 encephalitis is not rare not only in cord blood transplant recipients but also in recipients of HLA-mismatched unrelated donors. In this study, development of HHV-6 encephalitis was associated with a poor survival rate, and neurological sequelae remained in many patients.",
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AU - Oshima, K.

AU - Ikebe, T.

AU - Takano, K.

AU - Kanamori, H.

AU - Kondo, T.

AU - Ueda, Y.

AU - Mori, Takehiko

AU - Hashimoto, H.

AU - Ogawa, H.

AU - Eto, T.

AU - Ueki, T.

AU - Miyamoto, T.

AU - Ichinohe, T.

AU - Atsuta, Y.

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N2 - In this retrospective analysis using the Transplant Registry Unified Management Program, we identified 145 patients with human herpesvirus (HHV)-6 encephalitis among 6593 recipients. The cumulative incidences of HHV-6 encephalitis at 100 days after transplantation in all patients, recipients of bone marrow or PBSCs and recipients of cord blood were 2.3%, 1.6% and 5.0%, respectively. Risk factors identified in multivariate analysis were male sex, type of transplanted cells (relative risk in cord blood transplantation, 11.09, Po0.001; relative risk in transplantation from HLA-mismatched unrelated donor, 9.48, Po0.001; vs transplantation from HLA-matched related donor) and GvHD prophylaxis by calcineurin inhibitor alone. At 100 days after transplantation, the overall survival rate was 58.3% and 80.5% among patients with and without HHV-6 encephalitis, respectively (Po0.001). Neuropsychological sequelae remained in 57% of 121 evaluated patients. With both foscarnet and ganciclovir, full-dose therapy (foscarnet ?180 mg/kg, ganciclovir ?10 mg/kg) was associated with better response rate (foscarnet, 93% vs 74%, P = 0.044; ganciclovir, 84% vs 58%, P = 0.047). HHV-6 encephalitis is not rare not only in cord blood transplant recipients but also in recipients of HLA-mismatched unrelated donors. In this study, development of HHV-6 encephalitis was associated with a poor survival rate, and neurological sequelae remained in many patients.

AB - In this retrospective analysis using the Transplant Registry Unified Management Program, we identified 145 patients with human herpesvirus (HHV)-6 encephalitis among 6593 recipients. The cumulative incidences of HHV-6 encephalitis at 100 days after transplantation in all patients, recipients of bone marrow or PBSCs and recipients of cord blood were 2.3%, 1.6% and 5.0%, respectively. Risk factors identified in multivariate analysis were male sex, type of transplanted cells (relative risk in cord blood transplantation, 11.09, Po0.001; relative risk in transplantation from HLA-mismatched unrelated donor, 9.48, Po0.001; vs transplantation from HLA-matched related donor) and GvHD prophylaxis by calcineurin inhibitor alone. At 100 days after transplantation, the overall survival rate was 58.3% and 80.5% among patients with and without HHV-6 encephalitis, respectively (Po0.001). Neuropsychological sequelae remained in 57% of 121 evaluated patients. With both foscarnet and ganciclovir, full-dose therapy (foscarnet ?180 mg/kg, ganciclovir ?10 mg/kg) was associated with better response rate (foscarnet, 93% vs 74%, P = 0.044; ganciclovir, 84% vs 58%, P = 0.047). HHV-6 encephalitis is not rare not only in cord blood transplant recipients but also in recipients of HLA-mismatched unrelated donors. In this study, development of HHV-6 encephalitis was associated with a poor survival rate, and neurological sequelae remained in many patients.

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