Human Herpesvirus 6 Infection Following Haploidentical Transplantation: Immune Recovery and Outcome

Raffaella Greco, Lara Crucitti, Maddalena Noviello, Sara Racca, Daniele Mannina, Alessandra Forcina, Francesca Lorentino, Veronica Valtolina, Serena Rolla, Roee Dvir, Mara Morelli, Fabio Giglio, Maria Chiara Barbanti, Maria Teresa Lupo Stanghellini, Chiara Oltolini, Luca Aldo Edoardo Vago, Paolo Scarpellini, Andrea Assanelli, Matteo G. Carrabba, Sara MarktelMassimo Bernardi, Consuelo Corti, Massimo Clementi, Jacopo Peccatori, Chiara Bonini, Fabio Ciceri

Research output: Contribution to journalArticle

Abstract

Human herpesvirus 6 (HHV-6) is increasingly recognized as a potentially life-threatening pathogen in allogeneic hematopoietic stem cell transplantation (alloSCT). We retrospectively evaluated 54 adult patients who developed positivity to HHV-6 after alloSCT. The median time from alloSCT to HHV-6 reactivation was 34 days. HHV-6 was present in plasma samples from 31 patients, in bone marrow (BM) of 9 patients, in bronchoalveolar lavage fluid and liver or gut biopsy specimens from 33 patients, and in cerebrospinal fluid of 7 patients. Twenty-nine patients developed acute graft-versus-host disease (GVHD), mainly grade III-IV, and 15 had concomitant cytomegalovirus reactivation. The median absolute CD3+ lymphocyte count was 207 cells/µL. We reported the following clinical manifestations: fever in 43 patients, skin rash in 22, hepatitis in 19, diarrhea in 24, encephalitis in 10, BM suppression in 18, and delayed engraftment in 11. Antiviral pharmacologic treatment was administered to 37 patients; nonetheless, the mortality rate was relatively high in this population (overall survival [OS] at 1 year, 38% ± 7%). A better OS was significantly associated with a CD3+ cell count ≥200/µL at the time of HHV-6 reactivation (P = .0002). OS was also positively affected by the absence of acute GVHD grade III-IV (P = .03) and by complete disease remission (P = .03), but was not significantly influenced by steroid administration, time after alloSCT, type of antiviral prophylaxis, plasma viral load, or organ involvement. Although HHV-6 detection typically occurred early after alloSCT, better T cell immune reconstitution seems to have the potential to improve clinical outcomes. Our findings provide new insight into the interplay between HHV-6 and the transplanted immune system.
Original languageEnglish
Pages (from-to)2250 - 2255
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Volume22
Issue number12
DOIs
Publication statusPublished - Dec 1 2016

Keywords

  • Allogeneic hematopoietic stem cell transplantation
  • Human herpesvirus 6
  • T cell immune reconstitution

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Greco, R., Crucitti, L., Noviello, M., Racca, S., Mannina, D., Forcina, A., Lorentino, F., Valtolina, V., Rolla, S., Dvir, R., Morelli, M., Giglio, F., Barbanti, M. C., Lupo Stanghellini, M. T., Oltolini, C., Vago, L. A. E., Scarpellini, P., Assanelli, A., Carrabba, M. G., ... Ciceri, F. (2016). Human Herpesvirus 6 Infection Following Haploidentical Transplantation: Immune Recovery and Outcome. Biology of Blood and Marrow Transplantation, 22(12), 2250 - 2255. https://doi.org/10.1016/j.bbmt.2016.09.018