Background
Reactivation of human herpesvirus 6 (HHV‐6) occurs in 30%‐50% of patients (pts) who receive allogeneic (allo) hematopoietic stem cell transplant (HCT). However, the recommendation for post‐transplant HHV‐6 monitoring and treatment in pediatric pts is not well established.
Methods
HHV‐6 incidence rates and the clinical outcomes were reported for 139 pediatric pts (≤18 years) undergoing first allo‐HCT at City of Hope from July 2011 to July 2017, for whom HHV‐6 was monitored weekly throughout HCT hospitalization. For 57 pediatric pts, who underwent first HCT from January 2009 to July 2011, HHV‐6 was tested as clinically indicated and only rates of HHV‐6 viremia were collected.
Results
From July 2011 to July 2017, HHV‐6 was detected in 88/139 pts (63%). The frequency of HHV‐6 viremia was associated with malignant diagnoses, myeloablative conditioning, and cord blood HCT. Treatment with antiviral agents was offered to symptomatic pts with a higher viral load (VL), for whom the time to VL clearance was longer and the frequency of subsequent recurrences was higher. Pts with a lower VL cleared HHV‐6 without treatment. HHV‐6 viremia was associated with a higher frequency of grade II‐IV acute graft‐versus‐host disease (GVHD) (P = .022), but did not affect overall survival (OS), disease‐free survival (DFS), non‐relapsed mortality (NRM), myeloid, or platelet (Plt) engraftment.
Conclusions
HHV‐6 weekly screening is not necessary for all HCT pts but may be considered for high‐risk pts with malignant diagnoses undergoing cord blood HCT; otherwise, HHV‐6 should be tested as clinically indicated. Only symptomatic pts (especially with a high VL > 25 000) could benefit from treatment. HHV‐6 viremia at the time of initiation and administration of the conditioning regimen cleared promptly without the need to augment the transplant process.
Conclusions: Seven (78%) of 9 adult HCT recipients with ADV viremia treated with BCV are alive after the median follow up of 235 days post-BCV initiation. Our data support that, among highly immunosuppressed HCT recipients, early initiation of BCV treatment at a low level ADV VL is associated with virologic response along with the potential of improving ADV infection outcomes.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.