Clinical characteristics of human herpesvirus-6 myelitis after allogeneic hematopoietic stem cell transplantation and its favorable outcome by early intervention
Clinical characteristics of human herpesvirus-6 myelitis after allogeneic hematopoietic stem cell transplantation and its favorable outcome by early intervention
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DOI：
10.1038/s41409-019-0755-2
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发表时间：
2020-05-01
影响因子：
4.8
通讯作者：
Okamoto, Shinichiro
中科院分区：
文献类型：
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作者：
Shiroshita, Kohei;Mori, Takehiko;Okamoto, Shinichiro
同种异体造血干细胞移植（HSCT）后，人疱疹病毒-6 （HHV-6）可引起严重的中枢神经系统（CNS）紊乱，通常表现为脑炎。HHV-6的另一种表现是脊髓炎，尚未得到充分的评估。在这项研究中，我们回顾性分析了19例异体造血干细胞移植后发生HHV-6型脊髓炎的患者。中位发病时间为移植后20天（范围13-31天），移植后第40天累计发病率为4.1%。移植的中位年龄为50岁（范围17-61岁）。脑脊液（CSF）中HHV-6 DNA拷贝数中位数为3000拷贝/ml，范围200-100,000。最常见的症状是瘙痒、四肢/背部疼痛和麻木。3例患者在脊髓炎的临床过程中并发脑炎；在脊髓炎发病时，脑脊液中HHV-6拷贝数高于10,000拷贝/ml。所有患者在发病后不久开始使用抗病毒药物，导致康复。这些结果表明脊髓炎可能是异体造血干细胞移植后hhv -6相关中枢神经系统疾病的一个重要亚型，早期干预可能有利于其预后。移植医生应该认识到移植后早期的神经系统症状，如瘙痒、疼痛或麻木，这些症状可能是HHV-6型脊髓炎的征兆，也可能发展为脑炎。
After allogeneic hematopoietic stem cell transplantation (HSCT), human herpesvirus-6 (HHV-6) can cause serious central nervous system (CNS) disorder and typically presents as encephalitis. Another manifestation of HHV-6 is myelitis, which has not been fully evaluated. In this study, we retrospectively analyzed 19 patients who developed HHV-6 myelitis after allogeneic HSCT. Median onset was 20 days after transplantation (range, 13-31), with a cumulative incidence of 4.1% at day 40 after transplantation. Median age at transplant was 50 years (range, 17-61). Median copy number of HHV-6 DNA was 3000 copies/ml in cerebrospinal fluid (CSF; range, 200-100,000). The most common symptoms were pruritus, pain of the extremities/back, and numbness. Three patients subsequently developed encephalitis in the clinical course of myelitis; their HHV-6 copy numbers in CSF had been higher than 10,000 copies/ml at the onset of myelitis. Antiviral agents were initiated shortly after onset in all patients, resulting in recovery. These results suggest that myelitis would be an important subtype of HHV-6-associated CNS disorders after allogeneic HSCT, whose prognosis could be favorable by an early intervention. Transplant physicians should recognize early posttransplant neurological symptoms such as pruritus, pain, or numbness as possible signs of HHV-6 myelitis, which could also progress to encephalitis.