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Microbial Issues

Foscarnet against human herpesvirus (HHV)-6 reactivation after allo-SCT: breakthrough HHV-6 encephalitis following antiviral prophylaxis

Bone Marrow Transplantation volume 48, pages 257–264 (2013)Cite this article

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Abstract

High incidences of human herpesvirus (HHV)-6 encephalitis have recently been reported from several Japanese SCT centers. To evaluate the effect of low-dose foscarnet (PFA) in preventing HHV-6 infection among recipients of unrelated BM or cord blood (CB), we examined consecutive cohorts without prophylaxis against HHV-6 (Cohort 1, n=51) and with PFA prophylaxis (Cohort 2, PFA 50 mg/kg/day for 10 days after engraftment, n=67). Plasma real-time PCR assay was performed weekly. High-level reactivation defined as HHV-6 DNA⩾104 copies/mL by day 70 was the primary endpoint. No significant reduction of high-level reactivation was seen in Cohort 2 (19.4%) compared with Cohort 1 (33.8%, P=0.095). A trend was identified toward fewer high-level HHV-6 reactivations in Cohort 2 among recipients of unrelated BM (P=0.067), but no difference in incidence was observed among CB recipients (P=0.75). Breakthrough HHV-6 encephalitis occurred following PFA prophylaxis in three patients, and incidence of HHV-6 encephalitis did not differ between Cohort 1 (9.9%) and Cohort 2 (4.5%, P=0.24). In conclusion, 50 mg/kg/day of PFA does not effectively suppress HHV-6 reactivation and cannot prevent all cases of HHV-6 encephalitis. To effectively prevent HHV-6 encephalitis, alternative approaches based on the pathogenesis of HHV-6 encephalitis will probably be required.

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Acknowledgements

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest or financial conflict with the subject matter or materials discussed in the manuscript. No writing assistance was utilized in the production of this manuscript. This work was supported in part by grants from the Japanese Ministry of Health, Labor and Welfare and a non-profit organization, the Infection Control Oita Network.

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Authors and Affiliations

  1. Department of Hematology, Oita University Hospital, Oita, Japan

    M Ogata, T Satou, Y Inoue, K Takano, T Ikebe, T Ando, J Ikewaki, K Kohno & J Kadota

  2. Blood Transfusion Center, Oita University Hospital, Oita, Japan

    M Ogata

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

    A Nishida, M Saburi, Y Miyazaki, E Ohtsuka & Y Saburi

  4. Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan

    T Fukuda

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Ogata, M., Satou, T., Inoue, Y. et al. Foscarnet against human herpesvirus (HHV)-6 reactivation after allo-SCT: breakthrough HHV-6 encephalitis following antiviral prophylaxis. Bone Marrow Transplant 48, 257–264 (2013). https://doi.org/10.1038/bmt.2012.121

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