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Temporal relationship between HHV 6 and graft vs host disease in a patient after haplo-identical SCT and severe T-cell depletion

Bone Marrow Transplantation volume 46, pages 1151–1152 (2011)Cite this article

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In haplo-identical SCT (haploSCT), the risk of GVHD is virtually nil because of the necessity of T-cell depletion.1 In HLA-identical SCT human herpes virus type 6 (HHV6) reactivation is correlated with the occurrence of GVHD, but time-correlations between HHV6 and GVHD lack and reports are contradictory.2, 3, 4 In this report we describe a striking temporal relationship between HHV6 reactivation and GVHD in a patient after extensive T-cell depletion haploSCT.

A 22-year-old, previously healthy male was diagnosed with AML without cytogenetic or molecular abnormalities (World Health Organization classification AML, not otherwise specified). Treatment was started containing cytarabine 200 mg/m2 (7 days) and idarubicin 12 mg/m2 (3 days). The patient had a refractory clone. Reinduction with cytarabine 2000 mg/m2 (6 days) and amsacrine 120 mg/m2 (3 days) resulted in CR. Because of the high risk of early relapse, absence of an HLA-identical sibling and susceptibility to NK allo-reactivity (donor but not patient HLA-C2 positive and KIR2DL1 present in the donors genome), it was decided to perform a haploSCT. The conditioning regimen was similar to the Perugia protocol and consisted of TBI 8 Gy (day −9), thiotepa 5 mg/kg (days −8 and −7), fludarabine 40 mg/m2 (days −7 till −3) and anti-thymocyte globulin rabbit 5 mg/kg (days −6 till −2).1 At the time of transplant the donor was negative for HHV6 immunoglobulin M and positive for immunoglobulin G. The allograft was T-cell depletion (CD34 positive selection, CliniMACS Miltenyi, Bergisch Gladbach, Germany) containing 14.8 × 106 CD34+ cells/kg and only 0.3 × 104 CD3+ cells/kg. No post-SCT immune suppression or donor lymphocyte infusions were administered. Engraftment was complete from day +26 and persisted. Although not formally tested, the rapid recovery after myeloablative conditioning pointed to full donor chimerism.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, University Medical Center Maastricht, Maastricht, the Netherlands

    A V M Brands-Nijenhuis, H C Schouten & M van Gelder

  2. Department of Medical Microbiology, University Medical Center Maastricht, Maastricht, the Netherlands

    I H M van Loo

  3. Department of Microbiology, School for Public Health and Primary Care (CAPHRI), University Medical Center Maastricht, Maastricht, the Netherlands

    I H M van Loo

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  1. A V M Brands-Nijenhuis
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Correspondence to A V M Brands-Nijenhuis.

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Brands-Nijenhuis, A., van Loo, I., Schouten, H. et al. Temporal relationship between HHV 6 and graft vs host disease in a patient after haplo-identical SCT and severe T-cell depletion. Bone Marrow Transplant 46, 1151–1152 (2011). https://doi.org/10.1038/bmt.2010.245

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