Association of Inherited Chromosomally Integrated Human Herpesvirus 6 with Neurologic Symptoms and Management after Allogeneic Hematopoietic Cell Transplantation.
Association of Inherited Chromosomally Integrated Human Herpesvirus 6 with Neurologic Symptoms and Management after Allogeneic Hematopoietic Cell Transplantation.
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DOI：
10.1016/j.jtct.2021.05.029
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发表时间：
2021-09
影响因子：
3.2
通讯作者：
Hill JA
中科院分区：
文献类型：
--
作者：
Heldman MR;Job C;Maalouf J;Morris J;Xie H;Davis C;Stevens-Ayers T;Huang ML;Jerome KR;Fann JR;Zerr DM;Boeckh M;Hill JA
同种异体造血细胞移植（HCT）后人疱疹病毒6 （HHV-6）的再激活与神经系统并发症有关，但供体和/或受体遗传染色体整合的HHV-6 （iciHHV-6）对HCT后中枢神经系统（CNS）症状、诊断和治疗干预的影响尚不清楚。该研究的目的是：1)比较异体HCT供体和/或受体为iciHHV-6 （iciHHV-6pos）的患者与非供体和受体均为iciHHV-6 （icihhv - 6阴性）的患者在前100天内中枢神经系统症状的累积发生率；2)评估HHV-6检测在iciHHV-6pos患者中驱动潜在不必要干预的作用。我们对87名iciHHV-6pos和174名icihhv - 6阴性异体HCT受体进行了回顾性匹配队列研究。HHV-6检测是在医疗保健提供者的判断下进行的，他们不知道是否有HHV-6状态。CNS症状的累积发生率在iciHHV-6pos （N=37, 43%）和iciHHV-6neg HCT受体（N=81, 47%； P=0.63）中相似。在iciHHV-6pos （N= 6,7 %）和iciHHV-6neg（9%）中进行了相似比例的HHV-6血浆检测，并且在所有被检测的iciHHV-6pos和2例（13%）iciHHV-6neg hct中检测到HHV-6。这导致在iciHHV-6pos HCT后更频繁地接受hhv -6靶向抗病毒治疗（OR, 12.8; 95% CI 1.5-108.2），并伴有相关的副作用。2例无中枢神经系统活动性症状的iciHHV6pos患者的HHV-6血浆检测提示不必要的腰椎穿刺。同种异体HCT累及携带或不携带iciHHV-6的受体或供体后，中枢神经系统症状的累积发生率相似。在iciHHV-6pos HCT后错误地将HHV-6检测归为感染可能导致不必要的干预。检测iciHHV-6可能会改善患者管理。
Reactivation of human herpesvirus 6 (HHV-6) after allogeneic hematopoietic cell transplant (HCT) is associated with neurologic complications, but the impact of donor and/or recipient inherited chromosomally integrated HHV-6 (iciHHV-6) on post-HCT central nervous system (CNS) symptoms, diagnostic and therapeutic interventions is not well understood. The aims of the study were 1) to compare the cumulative incidence of CNS symptoms in the first 100 days following allogeneic HCT among patients with donor and/or recipient iciHHV-6 (iciHHV-6pos) to that of patients with neither donor nor recipient iciHHV-6 (iciHHV-6neg) and 2) to assess the role of HHV-6 detection in driving potentially unnecessary interventions in iciHHV-6pos patients. We performed a retrospective matched cohort study of 87 iciHHV-6pos and 174 iciHHV-6neg allogeneic HCT recipients. HHV-6 testing was performed at the discretion of healthcare providers, who were unaware of iciHHV-6 status. The cumulative incidence of CNS symptoms was similar in iciHHV-6pos (N=37, 43%) and iciHHV-6neg HCT recipients (N=81, 47%; P=0.63). HHV-6 plasma testing was performed in similar proportions of iciHHV-6pos (N=6, 7% ) and iciHHV-6neg (9%) and was detected in all tested iciHHV-6pos and 2 (13%) iciHHV-6neg HCTs. This resulted in more frequent HHV-6-targeted antiviral therapy after iciHHV-6pos HCT (OR, 12.8; 95% CI 1.5-108.2) with associated side effects. HHV-6 plasma detection in two iciHHV6pos patients without active CNS symptoms prompted unnecessary lumbar punctures. The cumulative incidence of CNS symptoms was similar after allogeneic HCT involving recipients or donors with and without iciHHV-6. Misattribution of HHV-6 detection as infection after iciHHV-6pos HCT may lead to unnecessary interventions. Testing for iciHHV-6 may improve patient management.
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影响因子：
4.5
作者：
Grinde B
通讯作者：
Grinde B
影响因子：
158.5
作者：
Zerr, DM;Meier, AS;Corey, L
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Corey, L
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Luppi, M.
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4.3
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Hill, Joshua A.;Koo, Sophia;Suarez, Belisa B. Guzman;Ho, Vincent T.;Cutler, Corey;Koreth, John;Armand, Philippe;Alyea, Edwin P., III;Baden, Lindsey R.;Antin, Joseph H.;Soiffer, Robert J.;Marty, Francisco M.
通讯作者：
Marty, Francisco M.