Risk factors of human herpesvirus 6 encephalitis/myelitis after allogeneic hematopoietic stem cell transplantation

Transpl Infect Dis. 2017 Jun;19(3). doi: 10.1111/tid.12682. Epub 2017 Apr 12.

Abstract

Background: Human herpesvirus 6 (HHV-6) encephalitis/myelitis is now a well-known complication after allogeneic stem cell transplantation (allo-HSCT), particularly after cord blood transplantation (CBT). In this study, we evaluated the risk factors of HHV-6 encephalitis/myelitis.

Methods: We evaluated 253 patients who received allo-HSCT from 2007 to 2015 at our institute. HHV-6 encephalitis/myelitis was defined as HHV-6 DNA detection in the cerebrospinal fluid or peripheral blood by polymerase chain reaction in the presence of typical manifestations without other concurrent condition that led to the manifestations.

Results: HHV-6 encephalitis/myelitis occurred in 11 patients (4.5%) (9 encephalitis, 3.7%; 2 myelitis, 0.8%). Multivariate analysis showed that CBT, mycophenolate mofetil (MMF) for graft-versus-host disease prophylaxis, history of allogeneic hematopoietic stem cell transplantation (allo-HSCT), and engraftment syndrome (ES) were significantly associated with incidence of HHV-6 encephalitis/myelitis (P=.025, P=.017, P=.017, and P=.014, respectively).

Conclusion: Although it has been shown that CBT, ES, and history of allo-HSCT are risk factors for HHV-6 encephalitis/myelitis, our study demonstrated MMF is also a risk factor for the disease.

Keywords: hematopoietic stem cell transplantation; human herpesvirus 6; mycophenolate mofetil.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cord Blood Stem Cell Transplantation / adverse effects*
  • DNA, Viral / isolation & purification
  • Encephalitis, Viral / epidemiology*
  • Encephalitis, Viral / virology
  • Female
  • Graft vs Host Disease / prevention & control
  • Hematologic Diseases / therapy*
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Herpesvirus 6, Human / isolation & purification*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Incidence
  • Male
  • Middle Aged
  • Mycophenolic Acid / therapeutic use
  • Myelitis / epidemiology*
  • Myelitis / virology
  • Polymerase Chain Reaction
  • Risk Factors
  • Roseolovirus Infections / epidemiology*
  • Roseolovirus Infections / virology
  • Transplantation Conditioning / adverse effects
  • Transplantation Conditioning / methods
  • Transplantation, Homologous / adverse effects
  • Young Adult

Substances

  • DNA, Viral
  • Immunosuppressive Agents
  • Mycophenolic Acid

Supplementary concepts

  • Human Herpesvirus 6 encephalitis