Early Human Herpesvirus Type 6 Reactivation after Allogeneic Stem Cell Transplantation: A Large-Scale Clinical Study
Early Human Herpesvirus Type 6 Reactivation after Allogeneic Stem Cell Transplantation: A Large-Scale Clinical Study
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DOI：
10.1016/j.bbmt.2011.12.579
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发表时间：
2012-07-01
影响因子：
4.3
通讯作者：
Yakoub-Agha, Ibrahim
中科院分区：
文献类型：
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作者：
Dulery, Remy;Salleron, Julia;Yakoub-Agha, Ibrahim
本研究调查了异基因干细胞移植（allo-SCT）后100天内人类疱疹病毒6型（HHV 6）再激活对患者结局的影响。每周通过定量PCR监测HHV 6血浆载量。在235例连续患者中，112例（48%）早期HHV 6 PCR试验阳性（A组），123例（52%）未阳性（B组）。HHV 6再激活在接受低强度预处理的患者中较不常见（P = 0.028）。在A组中，只有6例患者（5%）无症状;最常见的临床表现是发热（n = 60）、皮疹（n = 57）、腹泻（n = 51）、肺部并发症（n = 19）和神经系统疾病（n = 12）。与B组患者相比，A组患者发生血小板植入延迟（P = 0.003）和更频繁的II-IV级急性移植物抗宿主病（GVHD）（47%比B组30%; P = 0.009）。在多变量分析中，影响II-IV级急性GVHD发展的最重要因素是早期HHV 6再激活（P = 0.03）和无关供体状态（P <0.001）。HHV 6再激活对6个月生存率有不利影响（P = 0.04）。在接受抗病毒治疗的38例可评价患者中，34例HHV 6载量显著降低。我们的研究结果表明，异基因造血干细胞移植后HHV 6再激活与血小板植入延迟、移植后早期死亡率和急性GVHD的发生有关。在移植后早期，通过PCR仔细监测HHV 6是必要的。Biol Blood Marrow Transplant 18：1080-1089（2012）（C）2012美国血液和骨髓移植学会
This study investigated the impact of human herpesvirus type 6 (HHV6) reactivation within 100 days of allogeneic stem cell transplantation (allo-SCT) on patient outcomes. HHV6 plasma loads were monitored weekly by quantitative PCR. Of 235 consecutive patients, 112 (48%) had an early positive HHV6 PCR test (group A) and 123 (52%) did not (group B). HHV6 reactivation was less frequent in patients who received reduced-intensity conditioning (P = .028). In group A, only 6 patients (5%) were asymptomatic; the most common clinical manifestations were fever (n = 60), skin rash (n = 57), diarrhea (n = 51), pulmonary complications (n = 19), and neurologic disorders (n = 12). Compared with the patients in group B, those in group A experienced delayed platelet engraftment (P = .003) and more frequent grade II-IV acute graft-versus-host disease (GVHD) (47% versus 30% in group B; P = .009). In multivariate analysis, the most important factors influencing the development of grade II-IV acute GVHD development were early HHV6 reactivation (P = .03) and unrelated donor status (P < .001). HHV6 reactivation adversely influenced 6-month survival (P = .04). Of the 38 evaluable patients receiving antiviral treatment, 34 had a significantly decreased HHV6 load. Our findings indicate that HHV6 reactivation after allo-SCT is associated with delayed platelet engraftment, early posttransplantation mortality, and the development of acute GVHD. Careful monitoring of HHV6 by PCR is warranted during the early posttransplantation period. Biol Blood Marrow Transplant 18: 1080-1089 (2012) (C) 2012 American Society for Blood and Marrow Transplantation