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The Clinical Significance of Human Herpes Virus 6 (HHV-6) Dnaemia in 68 Hematopoietic Cell Transplant Recipients (HSCT)

Track: Poster Abstracts
Saturday, March 1, 2014, 6:45 PM-7:45 PM
Longhorn Hall E (Exhibit Level 1) (Gaylord Texan)
Roy F Chemaly, MD, MPH, FIDSA, FACP , Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Aline El Zakhem, MD , Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Dimpy P Shah, MD, MSPH , Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Nobuyoshi Mori, MD , Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Lior Nesher, MD , Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Ella Ariza-Heredia, MD , Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Victor E Mulanovich, MD , Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Partow Kebriaei, MD , Stem Cell Transplantation and Cellular Therapy, UT M.D. Anderson Cancer Center, Houston, TX
Chitra Hosing, MD , Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
Gabriela Rondon, MD , Stem Cell Transplantation & Cellular Therapy, UT M.D. Anderson Cancer Center, Houston, TX
Background: HHV-6 infection, mainly encephalitis, may cause significant morbidity and mortality among HSCT recipients. Despite the interest in HHV-6 in immunocompromised patients, however, little is known about the clinical significance of HHV-6 DNAemia in HSCT recipients.

 Methods: We reviewed the medical records of all HSCT recipients with positive HHV-6 DNA in serum (n=68) determined by real-time PCR assays between Nov 2008 and Apr 2012. We sought to determine the demographics, clinical characteristics, and outcome of HHV-6 DNAemia in this patient population.

 Results: Majority were white (43, 63%) males (35, 51%) with a median age of 54 y (range: 2- 74 y) who had undergone matched related (15, 22%), unrelated (19, 28%), and cord blood (18, 26%) transplants. Melphalan-based therapy (34, 50%) was the most common conditioning regimen. Corticosteroids (41, 61%), tacrolimus (52,76%), and mycophenolate (24, 35%) were commonly used. Acute GvHD was identified in 38 pts (56%). All pts were on prophylactic dose of valacyclovir or acyclovir prior to the first positive HHV-6 DNAemia and the geometric mean titer (GMT) was 16,336 copies/mL (range: 540 - 5431497 copies/mL) within a median time from HSCT of 29 d (range: 13-390 d). Main reasons for HHV-6 testing included persistent fever (40%), mental status changes (26%), and delayed engraftment (9%). Regardless of antiviral therapy which was administered in 62% of the pts (foscarnet; 88%), most patients (68%) recovered with negative DNAemia, had symptom resolution (53%), or progressed to meningoencephalitis (14%). HHV-6 related mortality occurred in 3 pts (5%) despite antiviral therapy (2 encephalitis and 1 pneumonitis).

 Conclusions: Despite receiving antiviral therapy, HHV-6 DNAemia progressed to end-organ disease with serious complications in some HSCT recipients but most pts recovered with or without therapy. Whether timely preemptive therapy prevented HHV-6 end-organ disease still needs to be determined in randomized trials.

Disclosures:
Nothing To Disclose
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