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Virus detection in the cerebrospinal fluid of hematopoietic stem cell transplant recipients is associated with poor patient outcomes: a CIBMTR contemporary longitudinal study

Bone Marrow Transplantation volume 54, pages 1354–1360 (2019)Cite this article

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Abstract

Limited data exist on characteristics of central nervous system viruses (CNS-V) in allogeneic hematopoietic stem cell transplant (HCT) recipients. Between 2007 and 2015, the Center for International Blood and Marrow Transplant Research (CIBMTR) received information on 27,532 patients undergoing HCT. Of these, centers reported 165 HCT recipients with CNS-V detected in cerebrospinal fluid within 6 months after HCT. CNS viruses predominantly included human herpes virus 6 (HHV-6) (73%), followed by Epstein-Barr Virus (10%), cytomegalovirus (3%), varicella zoster virus (3%), herpes simplex virus (3%) and Adenovirus (3%). Median time of viral detection in CNS was 31 days after HCT; and viral detection was earlier in patients with CNS HHV-6. Concurrent viremia occurred in 52% of patients. Cord blood transplant recipients (CBT) accounted for the majority (53%) of patients with CNS-V. Myeloablative conditioning (65%), use of fludarabine (63%), or use of anti-thymocyte globulin (61%) were also predominant. Overall survival from the time of detection of CNS-V was 50% at 6 months and 30% at 5 years. Infections were the leading cause of death (32%). In summary, CBT recipients predominated in the population with CNS-V. Outcomes after CNS-V were poor with significant mortality seen in the first 6 months.

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Authors and Affiliations

  1. Department of Medicine, Division of Infectious Disease, University of Colorado, 12700 E.19th Avenue, Denver, CO, USA

    Maheen Z. Abidi

  2. Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    Parameswaran Hari

  3. Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI, USA

    Min Chen & Soyoung Kim

  4. Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA

    Minoo Battiwala

  5. Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Parastoo Bahrami Dahi

  6. Division of Hematopoietic Stem Cell Transplantation, “Nino Jesus” Children Hospital, Madrid, Spain

    Miguel Angel Diaz

  7. Division of Experimental Medicine, Department of Medicine, Hematology Research Centre, Imperial College London, London, UK

    Robert Peter Gale

  8. Department of Medicine, Division of Hematology Oncology, University of Kansas School of Medicine, Kansas City, KS, USA

    Siddhartha Ganguly

  9. Department of Medical Oncology, Hematologic Malignancies and Bone Marrow Transplant, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA

    Usama Gergis

  10. Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA

    Jaime Green

  11. Division of Hematology, Blood, and Marrow Transplantation, University of Kentucky, Lexington, KY, USA

    Gerhard Hildebrandt

  12. Department of Medicine, University of Washington, Seattle, Washington; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Joshua A. Hill

  13. Department of Hematology and Oncology, University of Miami Miller School of Medicine, Miami, FL, USA

    Krishna Komanduri

  14. Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA

    Hillard Lazarus

  15. Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK

    David Marks

  16. Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Taiga Nishihori

  17. Department of Laboratory Medicine, Division of Therapeutic Immunology, Karolinska Institute, Stockholm, Sweden

    Richard Olsson

  18. Department of Hematology & Oncology, National Cancer Research Center East, Chiba, Japan

    Sachiko Seo

  19. Division of Hematology Oncology and Transplantation, Rush University Medical Center, Chicago, IL, USA

    Celalettin Ustun

  20. Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, MD, USA

    Jean Yared

  21. Department of Pediatrics, Children’s Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA

    Dwight Yin

  22. Department of Medicine, Division of Hematology & Oncology, University of Florida, Gainesville, FL, USA

    John Wingard

  23. Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA

    Baldeep Mona Wirk

  24. Divisions of Hematology/Oncology, Bone Marrow Transplantation and Infectious Disease, Nationwide Children’s Hospital, Columbus, OH, USA

    Jeffrey Auletta

  25. Pediatric Blood and Marrow Transplantation Program, University Medical Center, Utrecht, Netherlands

    Caroline Lindemans

  26. Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Marcie Riches

Authors
  1. Maheen Z. Abidi
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  2. Parameswaran Hari
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  3. Min Chen
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  4. Soyoung Kim
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  6. Parastoo Bahrami Dahi
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  7. Miguel Angel Diaz
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  8. Robert Peter Gale
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  9. Siddhartha Ganguly
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  10. Usama Gergis
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  11. Jaime Green
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  12. Gerhard Hildebrandt
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  13. Joshua A. Hill
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  14. Krishna Komanduri
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  15. Hillard Lazarus
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  16. David Marks
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  17. Taiga Nishihori
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  18. Richard Olsson
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  19. Sachiko Seo
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  20. Celalettin Ustun
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  21. Jean Yared
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  22. Dwight Yin
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  23. John Wingard
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  24. Baldeep Mona Wirk
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  25. Jeffrey Auletta
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  26. Caroline Lindemans
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  27. Marcie Riches
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Correspondence to Maheen Z. Abidi.

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Abidi, M.Z., Hari, P., Chen, M. et al. Virus detection in the cerebrospinal fluid of hematopoietic stem cell transplant recipients is associated with poor patient outcomes: a CIBMTR contemporary longitudinal study. Bone Marrow Transplant 54, 1354–1360 (2019). https://doi.org/10.1038/s41409-019-0457-9

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