Human herpesvirus 6 encephalitis in patients administered mycophenolate mofetil as prophylaxis for graft-versus-host disease after allogeneic hematopoietic stem cell transplantation
Human herpesvirus 6 encephalitis in patients administered mycophenolate mofetil as prophylaxis for graft-versus-host disease after allogeneic hematopoietic stem cell transplantation
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DOI：
10.1111/tid.13024
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发表时间：
2019-02-01
影响因子：
2.6
通讯作者：
Minami, Hironobu
中科院分区：
文献类型：
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作者：
Inui, Yumiko;Yakushijin, Kimikazu;Minami, Hironobu
人类疱疹病毒6型（HHV-6）脑炎是同种异体造血干细胞移植（alloo - hsct）后已知的危及生命的并发症。然而，很少有研究关注接受霉酚酸酯（MMF）联合钙调磷酸酶抑制剂预防移植物抗宿主病（GVHD）的患者发生HHV-6脑炎的情况。本研究旨在探讨MMF预防GVHD对同种异体造血干细胞移植后发生HHV-6脑炎的影响以及这种情况的特点。方法和结果我们回顾性分析了2010年4月至2015年12月在我院接受同种异体造血干细胞移植（83例）的73例患者。MMF （2-3 g/d）与钙调磷酸酶抑制剂一起给药。7例（8.0%）发生HHV-6型脑炎。从同种异体造血干细胞移植到HHV-6脑炎发病的中位时间为23天（范围17-98天）。在接受脐带血移植（CBT）和非CBT（即骨髓移植和外周血干细胞移植）的患者中，治疗后第100天HHV-6脑炎的累积发病率分别为12%和6% （P = 0.344）。脑炎的神经症状在非CBT组比CBT组更严重。所有诊断为HHV-6脑炎的患者均接受更昔洛韦或氟膦酸钠治疗。纳入的患者中没有人死于HHV-6脑炎。结论霉酚酸酯可能会增加CBT和非CBT患者发生严重HHV-6脑炎的频率。因此，MMF应谨慎使用，即使未接受CBT治疗的患者也应密切监测HHV-6脑炎。
Background Human herpesvirus 6 (HHV-6) encephalitis is a known life-threatening complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, few studies have focused on the occurrence of HHV-6 encephalitis in patients receiving mycophenolate mofetil (MMF) combined with a calcineurin inhibitor as prophylaxis for graft-versus-host disease (GVHD). This study aimed to investigate the impact of MMF administered for GVHD prophylaxis in the occurrence of HHV-6 encephalitis after allo-HSCT and the characteristics of this condition. Methods and results We retrospectively analyzed 73 patients who underwent allo-HSCT (83 transplants) at our hospital between April 2010 and December 2015. MMF (2-3 g/d) was administered along with a calcineurin inhibitor. Seven patients (8.0%) developed encephalitis due to HHV-6. The median period from allo-HSCT to the onset of HHV-6 encephalitis was 23 days (range, 17-98 days). The cumulative incidence of HHV-6 encephalitis on day 100 after treatment was 12% and 6% in patients who underwent cord blood transplantation (CBT) and non-CBT (ie, bone marrow transplantation and peripheral blood stem cell transplantation), respectively (P = 0.344). Neurological symptoms of encephalitis were more severe in non-CBT cases than those in CBT cases. All patients diagnosed with HHV-6 encephalitis were treated with ganciclovir or foscarnet. None of the enrolled patients died from HHV-6 encephalitis. Conclusions Mycophenolate mofetil may have the potential to increase the frequency of severe HHV-6 encephalitis in patients undergoing CBT and non-CBT. Thus, MMF should be administered with caution, and patients should be monitored closely for HHV-6 encephalitis even those who did not undergo CBT.