High Incidence of Human Herpes Virus 6-Associated Encephalitis/Myelitis following a Second Unrelated Cord Blood Transplantation
High Incidence of Human Herpes Virus 6-Associated Encephalitis/Myelitis following a Second Unrelated Cord Blood Transplantation
复制标题
DOI：
10.1016/j.bbmt.2010.05.009
复制
发表时间：
2010-11-01
影响因子：
4.3
通讯作者：
Akashi, Koichi
中科院分区：
文献类型：
--
作者：
Mori, Yasuo;Miyamoto, Toshihiro;Akashi, Koichi
人类疱疹病毒（HHV）6相关的边缘系统脑炎和/或脑炎是异基因造血干细胞移植（HSCT）后危及生命的中枢神经系统并发症之一。最近的报告显示，这些并发症与非亲缘脐带血移植（UCBT）的显着相关性。我们回顾性分析了228异基因造血干细胞移植受体在我们的单一机构，13例（5.7%）被诊断为HHV 6相关脑炎/脑炎。在51例UCBT受者中有8例（15.7%）和177例接受骨髓或外周血干细胞移植的受者中有5例（2.8%）记录了该并发症，表明UCBT受者中发生该并发症的发生率较高（P = .0005）。此外，与仅接受1次HSCT的受者（169例受者中的6例[3.6%]，P = 0.018）相比，接受2次或2次以上HSCT的受者（59例受者中的7例[11.9%]）更常发生HHV 6相关脑炎/脑炎。值得注意的是，当分析仅限于第二个或更多UCBT接受者时，这种并发症的发生率增加到28.6%（21例接受者中的6例）。所有13例患者在脑炎发作前均出现植入前免疫应答。2例患者在HHV 6相关脑炎/脑炎发作时表现出典型症状，如记忆障碍、定向障碍和意识障碍。然而，4例患者仅表现为感觉迟钝和瘙痒，被描述为钙调神经磷酸酶抑制剂诱导的疼痛综合征（CIPS）患者的典型表现，其余7例同时表现出这两种症状，表明CIPS样症状可能是HHV 6相关性肌病的表现。因此，医生应该警惕这种罕见但往往致命的并发症，特别是对于那些接受2个或更多HSCT使用UCB。
Human herpes virus (HHV)6-associated limbic encephalitis and/or myelitis is one of the life-threatening central nervous system complications following allogeneic hematopoietic stem cell transplantation (HSCT). Recent reports have shown significant correlations of these complications with unrelated cord blood transplantation (UCBT). We retrospectively analyzed 228 allogeneic HSCT recipients in our single institution; 13 patients (5.7%) were diagnosed with HHV6-associated encephalitis/myelitis. This complication was documented in 8 of 51 UCBT recipients (15.7%) and 5 of 177 recipients (2.8%) transplanted with bone marrow or peripheral blood stem cells, indicating a higher incidence of this complication occurring in UCBT recipients (P = .0005). In addition, HHV6-associated encephalitis/myelitis occurred more frequently in recipients who underwent 2 or more HSCTs (7 of 59 recipients [11.9%]), compared to those who received only 1 HSCT (6 of 169 recipients [3.6%], P = .018). Of note, the incidence of this complication increased to 28.6% (6 of 21 recipients), when the analysis was restricted to a second or more UCBT recipients. All 13 patients presented preengraftment immune response prior to the onset of encephalitis. Two patients manifested typical symptoms at the onset of HHV6-associated encephalitis/myelitis, such as memory dysfunction, disorientation, and consciousness disturbance. However, 4 patients presented only with dysesthesia and pruritus, described as typical manifestations of patients with calcineurin-inhibitor-induced pain syndrome (CIPS), and the remaining 7 showed both symptoms, indicating that CIPS-like symptoms might be manifestations of HHV6-associated myelitis. Thus, physicians should be alert to this rare but often fatal complication, particularly for those who receive 2 or more HSCTs using UCB.