de Pagter P J A, Schuurman R, Keukens L, Schutten M, Cornelissen J J, van Baarle D, Fries E, Sanders E A M, Minnema M C, van der Holt B R, Meijer E, Boelens J J
Department of Immunology/Hematology and BMT, University Medical Center Utrecht, Utrecht, The Netherlands.
Bone Marrow Transplant. 2013 Nov;48(11):1460-4. doi: 10.1038/bmt.2013.78. Epub 2013 Jun 17.
Hematopoietic SCT (HSCT) is often complicated by viral reactivations. In this retrospective cohort study (January 2004-August 2008), predictors for human herpes virus 6 (HHV6)-reactivation and associations between HHV6-reactivation and clinical outcomes after allogeneic HSCT were studied. HHV6 DNA load in plasma was monitored weekly by quantitative real-time PCR. Associations between the main end point HHV6-reactivation and other end points, that is, acute GVHD (aGVHD) and NRM were analyzed using Cox proportional hazard models. In total, 108 patients receiving either a myeloablative (MA; n=60) or non-myeloablative (NMA; n=48) conditioning regimen were included. Median age was 40 years (range 17-65); median follow-up was 20 months (range 3-36). In 16/60 (27%) patients with MA conditioning regimen, a HHV6 reactivation was observed (mean viral load 50 323 cp/mL) compared with 2/48 (4%) patients with a NMA conditioning regimen with low viral load (mean 1100 cp/mL). In multivariate analysis, MA conditioning was the only predictor for HHV6 reactivation (P=0.02). In addition, HHV6 reactivation was associated with grades 2-4 aGVHD (P<0.001) and NRM (P=0.03). Regular monitoring of HHV6 reactivation after HSCT might be important in MA HSCT patients to enable early initiation of antiviral treatment or to anticipate aGVHD, all of which may improve clinical outcome.
造血干细胞移植（HSCT）常并发病毒再激活。在这项回顾性队列研究（2004年1月至2008年8月）中，研究了异基因造血干细胞移植后人类疱疹病毒6型（HHV6）再激活的预测因素以及HHV6再激活与临床结局之间的关联。通过定量实时PCR每周监测血浆中的HHV6 DNA载量。使用Cox比例风险模型分析主要终点HHV6再激活与其他终点（即急性移植物抗宿主病（aGVHD）和非复发死亡率（NRM））之间的关联。总共纳入了108例接受清髓性（MA；n = 60）或非清髓性（NMA；n = 48）预处理方案的患者。中位年龄为40岁（范围17 - 65岁）；中位随访时间为20个月（范围3 - 36个月）。在接受MA预处理方案的16/60（27%）患者中观察到HHV6再激活（平均病毒载量50323拷贝/mL），而接受NMA预处理方案的2/48（4%）患者病毒载量较低（平均1100拷贝/mL）。在多变量分析中，MA预处理是HHV6再激活的唯一预测因素（P = 0.02）。此外，HHV6再激活与2 - 4级aGVHD（P < 0.001）和NRM（P = 0.03）相关。对HSCT后HHV6再激活进行定期监测对于MA HSCT患者可能很重要，以便能够早期开始抗病毒治疗或预测aGVHD，所有这些都可能改善临床结局。
