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Reactivation of human herpesvirus 6 in pediatric allogeneic hematopoietic stem cell transplant recipients
Author(s) -
Pawlowska Anna B.,
Karras Nicole A.,
Liu Huaying,
DiMundo Julie,
Cheng Jerry C.,
Sun Weili,
Armenian Saro,
Yang Dongyun,
Palmer Joycelynne M.,
Bell Alison,
Tahoun Ahmed,
Tegtmeier Bernard,
Dadwal Sanjeet,
Rosenthal Joseph
Publication year - 2021
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13453
Subject(s) - medicine , viremia , human herpesvirus 6 , cord blood , cumulative incidence , hematopoietic stem cell transplantation , incidence (geometry) , transplantation , gastroenterology , immunology , human immunodeficiency virus (hiv) , herpesviridae , viral disease , physics , optics
Background Reactivation of human herpesvirus 6 (HHV‐6) occurs in 30%‐50% of patients (pts) who receive allogeneic (allo) hematopoietic stem cell transplant (HCT). However, the recommendation for post‐transplant HHV‐6 monitoring and treatment in pediatric pts is not well established. Methods HHV‐6 incidence rates and the clinical outcomes were reported for 139 pediatric pts (≤18 years) undergoing first allo‐HCT at City of Hope from July 2011 to July 2017, for whom HHV‐6 was monitored weekly throughout HCT hospitalization. For 57 pediatric pts, who underwent first HCT from January 2009 to July 2011, HHV‐6 was tested as clinically indicated and only rates of HHV‐6 viremia were collected. Results From July 2011 to July 2017, HHV‐6 was detected in 88/139 pts (63%). The frequency of HHV‐6 viremia was associated with malignant diagnoses, myeloablative conditioning, and cord blood HCT. Treatment with antiviral agents was offered to symptomatic pts with a higher viral load (VL), for whom the time to VL clearance was longer and the frequency of subsequent recurrences was higher. Pts with a lower VL cleared HHV‐6 without treatment. HHV‐6 viremia was associated with a higher frequency of grade II‐IV acute graft‐versus‐host disease (GVHD) ( P = .022), but did not affect overall survival (OS), disease‐free survival (DFS), non‐relapsed mortality (NRM), myeloid, or platelet (Plt) engraftment. Conclusions HHV‐6 weekly screening is not necessary for all HCT pts but may be considered for high‐risk pts with malignant diagnoses undergoing cord blood HCT; otherwise, HHV‐6 should be tested as clinically indicated. Only symptomatic pts (especially with a high VL > 25 000) could benefit from treatment. HHV‐6 viremia at the time of initiation and administration of the conditioning regimen cleared promptly without the need to augment the transplant process.