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Infections

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

Bone Marrow Transplantation volume 52, pages 1563–1570 (2017)Cite this article

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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, P<0.001; relative risk in transplantation from HLA-mismatched unrelated donor, 9.48, P<0.001; 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 (P<0.001). 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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Acknowledgements

We express our appreciation for the work of all of the physicians and data managers who contributed valuable data to the JSHCT and JDCHCT. We also thank members of the Transplant Registry Unified Management committees for their data management. This work was supported in part by the Practical Research Project for Allergic Diseases and Immunology from the Japan Agency for Medical Research and Development, AMED (to YA) and Research Program on Practical Research for Innovative Cancer Control from AMED (to TF).

Author contributions

MO designed the study, analyzed the data and wrote the manuscript. KO, TI and KT designed the study, analyzed the data and revised the manuscript. HK, TK, YU, TM, HH, HO, TE, TU and TM collected data and revised the manuscript. TI revised the manuscript and was responsible for data management for the JDCHCT. YA managed the registry database and revised the manuscript. TF designed the study, revised the manuscript and was responsible for the Complication Working Group.

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Authors and Affiliations

  1. Department of Medical Oncology and Hematology, Oita University Faculty of Medicine, Oita, Japan

    M Ogata, T Ikebe & K Takano

  2. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    K Oshima & T Ichinohe

  3. Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan

    H Kanamori

  4. Department of Hematology/Oncology, Kyoto University Hospital, Kyoto, Japan

    T Kondo

  5. Department of Hematology/Oncology, Kurashiki Central Hospital, Okayama, Japan

    Y Ueda

  6. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    T Mori

  7. Department of Hematology, Kobe General Hospital/Institute of Biomedical Research and Innovation, Hyogo, Japan

    H Hashimoto

  8. Division of Hematology, Hyogo College of Medicine, Hyogo, Japan

    H Ogawa

  9. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    T Eto

  10. Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan

    T Ueki

  11. Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    T Miyamoto

  12. Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan

    Y Atsuta

  13. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Aichi, Japan

    Y Atsuta

  14. Division of Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan

    T Fukuda

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  1. M Ogata
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on behalf of the Complication Working Group of the Japan Society for Hematopoietic Cell Transplantation

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Correspondence to M Ogata.

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Ogata, M., Oshima, K., Ikebe, T. et al. Clinical characteristics and outcome of human herpesvirus-6 encephalitis after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 52, 1563–1570 (2017). https://doi.org/10.1038/bmt.2017.175

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