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Absence of early HHV‐6 reactivation after cord blood allograft predicts powerful graft‐versus‐tumor effect
Author(s) -
Rashidi Armin,
Ebadi Maryam,
Said Bassil,
Cao Qing,
Shanley Ryan,
Curtsinger Julie,
Bejanyan Nelli,
Warlick Erica D.,
Green Jaime S.,
Brunstein Claudio G.,
Miller Jeffrey S.,
Weisdorf Daniel J.
Publication year - 2018
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.25141
Subject(s) - medicine , hazard ratio , cumulative incidence , incidence (geometry) , confidence interval , univariate analysis , cord blood , gastroenterology , human herpesvirus 6 , malignancy , immunology , proportional hazards model , transplantation , herpesviridae , virus , viral disease , multivariate analysis , physics , optics
Approximately 75% of cord blood transplant (CBT) recipients experience human herpes virus‐6 (HHV‐6) reactivation. Considering the immunomodulatory effects of HHV‐6, we hypothesized that early HHV‐6 reactivation may influence the risk of relapse of the underlying hematologic malignancy. In 152 CBT recipients with hematological malignancies, we determined the association between HHV‐6 reactivation by day +28 and 2‐year cumulative incidence of relapse. In univariate analysis, the absence of HHV‐6 reactivation ( n = 32) was associated with less relapse (26 [18‐35]% vs. 7 [0‐17]% in groups with vs. without HHV‐6 reactivation, respectively; P = .03). This difference was due to a remarkably low relapse incidence among patients without HHV‐6 reactivation. In multivariable analysis, the absence of HHV‐6 reactivation was associated with less relapse (hazard ratio [95% confidence interval]: 0.2 [0.05‐0.9], P = .03). This association was independent of patient‐, disease‐, and transplant‐related characteristics known to influence the risk of relapse. Natural killer cell and T‐cell reconstitution at day +28 were similar between patients with vs. without HHV‐6 reactivation. Our results suggest that CB allografts not complicated by HHV‐6 reactivation by day +28 have a powerful graft‐versus‐tumor effect. Knowledge about early HHV‐6 reactivation may stratify patients at day +28 into low vs. high relapse risk groups.