Outcomes of Haploidentical Stem Cell Transplant Recipients With HHV-6B Reactivation

Outcomes of Haploidentical Stem Cell Transplant Recipients With HHV-6B Reactivation OPEN FORUM INFECTIOUS DISEASES Handley, G., Yepes, A., Eliassen, E., Dominguez, G., Pasikhova, Y., Klinkova, O., Baluch, A., Febres-Aldana, A. J., Alsina, M., Elmariah, H., Khimani, F., Hansen, D. K., Freeman, C. L., Jain, M. D., Locke, F., Lazaryan, A., Liu, H. D., Mishra, A., Mirza, A., Nishihori, T., Ochoa, L., Perez, L., Pidala, J., Puglianini, O., Nieder, M., Perna, F., Kim, J., Bejanyan, N., Faramand, R. 2024; 11 (10): ofae564

Abstract

Human herpesvirus 6B (HHV-6B) frequently reactivates following allogeneic stem cell transplant (alloHCT). Consensus guidelines note that haploidentical alloHCT may represent a high-risk population for which there is little evidence; this warrants further investigation.In this single-center retrospective study, we evaluated 188 consecutive adult patients receiving haploidentical alloHCT between 11/2014 and 11/2020 and compared outcomes between patients with HHV-6B reactivation receiving targeted antiviral therapy and those who were clinically observed.Of the 58 included patients, 21 (36.2%) received antiviral therapy for HHV-6B reactivation with foscarnet (n = 19) or ganciclovir (n = 2). There were no differences in patient or disease characteristics between treated and observed patients. Treated patients were more likely to have high-level DNAemia (85.7% vs 40.5%; P < .001) and had higher peak viral quantitative measurements (median log10, 4.65 vs 3.84; P < .001). The median time to clearance from plasma (interquartile range) was 13 (7.25-20.00) days for all patients and was not significantly different between groups. There were no differences in episodes of encephalitis, grade III/IV acute graft-vs-host disease (GVHD), or time to neutrophil or platelet engraftment among treated vs observed patients. Day 100 nonrelapse mortality was not significantly different in the multivariate analysis; however, the presence of central nervous system symptoms was strongly associated with worse survival (hazard ratio, 4.11; 95% CI, 1.27-13.34; P = .018).We did not observe a difference in clinical outcomes between the treated and observed groups of patients with HHV-6B reactivation following haploidentical alloHCT. With the rising use of haploidentical transplant and post-transplant cyclophosphamide GVHD prevention platforms, prospective studies are needed to further characterize the risk and outcomes associated with HHV-6B reactivation and therapy.

View details for DOI 10.1093/ofid/ofae564

View details for Web of Science ID 001336265800012

View details for PubMedID 39411216

View details for PubMedCentralID PMC11475747