Preemptive therapy of human herpesvirus-6 encephalitis with foscarnet sodium for high-risk patients after hematopoietic SCT

Ishiyama, Ken; Katagiri, Takamasa; Hoshino, Takumi; Yoshida, Takashi; Yamaguchi, Masaki; Nakao, Shinji

doi:10.1038/bmt.2010.201

Cited by 74 publications

(53 citation statements)

References 39 publications

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“…Ishiyama et al 66,67 have published preliminary results of a small prospective study, suggesting the efficacy and safety of foscarnet as a prophylactic treatment in the HSCT setting. Neurological disorders occurred in 0/8 patients receiving prophylactic foscarnet compared with 4/10 control patients, including 2 with HHV-6 encephalitis.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, a study with 15 CBT patients by Ishiyama et al 66 suggested that preemptive foscarnet therapy may be effective if HHV-6 is monitored thrice weekly, suggesting the potential need for prophylactic treatment based on the dynamic of HHV-6 load in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Forest plots were built using STATA's user-developed 'metan' procedure. 33 63 Mixed 4500 copies per mL detected in whole blood 68.5% (37/54) 32.1% (9/28) Ishiyama et al 66 Adult 4100 copies per mL detected in plasma 80% (12/15) 0% (0/5) a Chevallier et al 10 Adult Defined by either one positive PCR test of 41000 copies per mL detected in whole blood or two consecutive positive PCR tests of 4100 copies per mL detected in whole blood 80% (12/15) 42.5% (17/40)…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

HHV-6 encephalitis in umbilical cord blood transplantation: a systematic review and meta-analysis

Scheurer

Pritchett

Amirian

et al. 2012

Bone Marrow Transplant

105

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Reactivation of human herpesvirus-6 (HHV-6) frequently occurs following hematopoietic SCT (HSCT), and has been associated with clinical consequences in many patient populations. HHV-6 reactivation and HHV-6 encephalitis seem to occur more frequently in patients undergoing HSCT with cord blood (CB) as the stem cell source. We have conducted a systematic literature review and meta-analysis to investigate the clinical significance of this correlation. A systematic review of publications indexed in PubMed was performed for HSCT studies published over the past 10 years that fit inclusion criteria. Data on prevalences of HHV-6 reactivation and HHV-6 encephalitis post HSCT were abstracted from 19 papers. Meta-analyses were conducted to calculate combined prevalence estimates. The prevalences of HHV-6 reactivation and encephalitis were compared among CB vs non-CB HSCT. Prevalences of HHV-6 reactivation and HHV-6 encephalitis were significantly higher in patients receiving CB as the stem cell source than in patients receiving another stem cell source (72.0% vs 37.4%, Po0.0001; 8.3% vs 0.50%, Po0.0001, respectively). HHV-6 reactivation and HHV-6 encephalitis are significant complications in the post-HSCT setting, particularly in patients receiving CB as the stem cell source. Thus, patients undergoing umbilical CB transplantation should be closely monitored for HHV-6 reactivation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

HHV-6 encephalitis in umbilical cord blood transplantation: a systematic review and meta-analysis

Scheurer

Pritchett

Amirian

et al. 2012

Bone Marrow Transplant

105

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“…Actually, trials of plasma HHV-6 DNA-guided preemptive approaches have proven inadequate in preventing the development of HHV-6 encephalitis because of the dynamic kinetics of plasma HHV-6 DNA. 7,90 Prophylactic administration of anti-HHV-6 antivirals will suppress HHV-6 replication and may effectively prevent the development of HHV-6 encephalitis. However, the toxicity of currently applicable antivirals limits the practical application for prophylaxis.…”

Section: Prevention: We Do Not Know Measures For Preventing Hhv-6 Encmentioning

confidence: 99%

Human herpesvirus-6 encephalitis after allogeneic hematopoietic cell transplantation: What we do and do not know

Ogata

Fukuda²,

Teshima

2015

Bone Marrow Transplant

102

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Human herpesvirus-6 (HHV-6) encephalitis following allogeneic hematopoietic cell transplantation is a serious and often fatal complication accompanying reactivation of HHV-6B. Incidence varies among studies, but is reportedly 0-11.6% after bone marrow or PBSC transplantation and 4.9-21.4% after umbilical cord blood transplantation, typically around 2-6 weeks post transplant. Symptoms are characterized by memory loss, loss of consciousness and seizures. Magnetic resonance imaging (MRI) typically shows bilateral signal abnormalities in the limbic system. This complication is considered to represent acute encephalitis caused by direct virally induced damage to the central nervous system, but our understanding of the etiologies and pathogenesis is still limited. The mortality rate attributable to this pathology remains high, and survivors are often left with serious sequelae such as impaired memory and epilepsy. Despite the poor prognosis, no validated treatments or preventative measures have been established. Establishment of preventative strategies represents an important challenge. This article reviews the current knowledge of the clinical features, incidence, pathogenesis and treatment of HHV-6 encephalitis, and discusses issues needing clarification in the future to overcome this serious complication.

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“…However, PCR detection of HHV6 DNA in CSF associated with brain MRI abnormalities and a clinical diagnosis of nonspecific encephalopathy must lead to the urgent initiation of systemic antiviral treatment, usually based on intravenous ganciclovir or foscarnet sodium. 10,11 Antiviral therapy should be started early to prevent brain damage even if it cannot prevent all cases of HHV6 encephalopathy in allo-HSCT recipients due to the dynamic kinetics of plasma HHV6 viral load. 12,13 Olson et al 14 recently reported in a single-centre retrospective study, 94% HHV6 reactivation early after UCBT in 125 patients with a five-time lower incidence of HHV6 encephalitis (≈2% instead of the usual 10% in UCBT recipients).…”

mentioning

confidence: 99%

Human herpesvirus-6 acute limbic encephalitis after unrelated umbilical cord blood transplantation successfully treated with ganciclovir

Camus

Bouwyn

Chamseddine

et al. 2015

Bone Marrow Transplant

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Preemptive therapy of human herpesvirus-6 encephalitis with foscarnet sodium for high-risk patients after hematopoietic SCT

Cited by 74 publications

References 39 publications

HHV-6 encephalitis in umbilical cord blood transplantation: a systematic review and meta-analysis

HHV-6 encephalitis in umbilical cord blood transplantation: a systematic review and meta-analysis

Human herpesvirus-6 encephalitis after allogeneic hematopoietic cell transplantation: What we do and do not know

Human herpesvirus-6 acute limbic encephalitis after unrelated umbilical cord blood transplantation successfully treated with ganciclovir

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