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Post-Transplant Events

Plasma HHV-6 viral load-guided preemptive therapy against HHV-6 encephalopathy after allogeneic stem cell transplantation: a prospective evaluation

Bone Marrow Transplantation volume 41, pages 279–285 (2008)Cite this article

Abstract

Human herpesvirus 6 (HHV-6) causes life-threatening encephalopathy in recipients of allogeneic SCT, but no consensus has been reached regarding appropriate preventive methods. This study evaluated a plasma HHV-6 viral load-guided preemptive approach against HHV-6-associated encephalopathy. Plasma real-time PCR assay was performed once a week. Among 29 patients, 19 developed positive plasma HHV-6 DNA. Median maximum plasma HHV-6 DNA was 4593.5 copies/ml plasma (range, 150.0–127 891.0 copies/ml plasma). In one of eight events with low-level HHV-6 DNA (defined as <1000 copies/ml plasma) and four of seven events with mid-level HHV-6 DNA (1000–9999.5 copies/ml plasma), HHV-6 loads in plasma subsequently continued increasing. Ganciclovir was administered against six of nine patients with high-level HHV-6 DNA (⩾10 000 copies/ml plasma). High-level HHV-6 DNA resolved similarly in both groups with or without ganciclovir therapy. Among the nine patients with high-level HHV-6 DNA two developed encephalopathy. As encephalopathy developed before the detection of high-level HHV-6 DNA in plasma, these two patients had not received preemptive ganciclovir therapy. In conclusion, our preemptive approach against HHV-6-associated encephalopathy cannot prevent all cases of HHV-6 encephalopathy in SCT recipients due to the dynamic kinetics of plasma HHV-6 viral load.

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Acknowledgements

This work was supported in part by grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

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Authors and Affiliations

  1. Blood Transfusion Center, Oita University Faculty of Medicine, Oita, Japan

    M Ogata & T Saikawa

  2. Division of Pathogenesis and Disease Control, Department of Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan

    M Ogata, T Satou, R Kawano, K Goto, J Ikewaki, K Kohno & J-i Kadota

  3. Department of Hematology, Oita Prefectural Hospital, Oita, Japan

    T Ando, Y Miyazaki, E Ohtsuka & Y Saburi

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  1. M Ogata
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  2. T Satou
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Correspondence to M Ogata.

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Ogata, M., Satou, T., Kawano, R. et al. Plasma HHV-6 viral load-guided preemptive therapy against HHV-6 encephalopathy after allogeneic stem cell transplantation: a prospective evaluation. Bone Marrow Transplant 41, 279–285 (2008). https://doi.org/10.1038/sj.bmt.1705907

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