Clinical outcomes of human herpesvirus 6 reactivation after hematopoietic stem cell transplantation
Clinical outcomes of human herpesvirus 6 reactivation after hematopoietic stem cell transplantation
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DOI：
10.1086/428060
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发表时间：
2005-04-01
影响因子：
11.8
通讯作者：
Boeckh, M
中科院分区：
文献类型：
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作者：
Zerr, DM;Corey, L;Boeckh, M
背景。尽管已知人类疱疹病毒 6 (HHV-6) 在造血干细胞移植 (HSCT) 过程中会重新激活，但这一发现的临床意义仍存在争议。我们使用 HHV-6 定量 PCR 检测来分析从 110 名同种异体 HSCT 受者队列中前瞻性收集的血浆样本，以评估 HHV-6 感染的临床效果。对病历进行回顾性审查以确定临床终点。结果。 110 名受试者中有 52 名 (47%) 发生了 HHV-6 重新激活。增加随后 HHV-6 再激活风险的因素包括首次缓解以外时间发生的血液恶性肿瘤（调整后的 P = .002）、供体和受体性别不匹配（调整后的 P = .05）、年龄较小（调整后的 P = .01）和接受糖皮质激素（调整后的 P = .06）。 HHV-6 重新激活与随后的全因死亡率（调整后的风险比 [HR]，2.9；95% 置信区间 [CI]，1.1-7.5）、3-4 级移植物抗宿主病 (GVHD)（调整后的 HR，4.9；95% CI，1.5-16）、较低的单核细胞植入概率（调整后的 HR，0.42；95% CI，1.5-16）相关。 95% CI; 0.22-0.80），血小板植入概率较低（调整后的 HR，0.47；95% CI，0.21-1.1；P = .05）和较高的血小板输注需求（调整后的 P = .02）。较高水平的 HHV-6 DNA 与随后的中枢神经系统 (CNS) 功能障碍相关（HR，21；95% CI，1.8-249）。结论。 HHV-6 再激活在同种异体 HSCT 后很常见，并与随后的单核细胞和血小板植入延迟、血小板输注需求增加、全因死亡率、3-4 级 GVHD 和 CNS 功能障碍相关。
Background. Although human herpesvirus 6 (HHV-6) is known to reactivate during hematopoietic stem cell transplantation (HSCT), the clinical significance of this finding is controversial.Methods. We used a quantitative PCR test for HHV-6 to assay plasma samples prospectively collected from a cohort of 110 allogeneic HSCT recipients to evaluate the clinical effects of HHV-6 infection. A retrospective review of medical records was performed to determine clinical end points.Results. HHV-6 reactivation occurred in 52 (47%) of the 110 subjects. Factors that increased the risk of subsequent HHV-6 reactivation were hematologic malignancy that occurred at a time other than the first remission (adjusted P = .002), a mismatch in the sexes of donor and recipient (adjusted P = .05), younger age (adjusted P = .01), and the receipt of glucocorticoids (adjusted P = .06). HHV-6 reactivation was associated with subsequent all-cause mortality (adjusted hazard ration [HR], 2.9; 95% confidence interval [CI], 1.1-7.5), grade 3-4 graft-versus-host disease (GVHD) (adjusted HR, 4.9; 95% CI, 1.5-16), a lower probability of monocyte engraftment (adjusted HR, 0.42; 95% CI; 0.22-0.80), a lower probability of platelet engraftment (adjusted HR, 0.47; 95% CI, 0.21-1.1; P = .05) and a higher platelet transfusion requirement (adjusted P = .02). A higher level of HHV-6 DNA was associated with subsequent central nervous system (CNS) dysfunction (HR, 21; 95% CI, 1.8-249).Conclusions. HHV-6 reactivation is common after allogeneic HSCT and is associated with subsequent delayed monocyte and platelet engraftment, increased platelet transfusion requirements, all-cause mortality, grade 3-4 GVHD, and CNS dysfunction.