Medical Microbiology and Immunology Department, Faculty of Medicine, Alexandria University, 0 Khartoum Square, Azarita, Alexandria, Egypt.
Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Virol J. 2023 Feb 4;20(1):20. doi: 10.1186/s12985-023-01980-w.
Immunocompromised patients face reactivation of latent viruses that increase the risk of morbidity.
The study aimed to detect human herpes virus 6 (HHV-6) reactivation among allogeneic (allo) and autologous (auto) hematopoietic stem cell transplant (HSCT) recipients and to correlate potentially attributed clinical manifestations to HHV-6 DNA plasma level.
A prospective study included all (forty) patients undergoing allo and auto-HSCT from Jan 2020 till June 2022. Plasma samples were collected for HHV-6 serology, and for HHV-6 quantitative PCR at post-transplantation weeks 2, 4, 6. Demographic and clinical data were recorded.
Out of 40 peripheral blood stem cell transplant (PBSCT) recipients, 34 (85%) were HHV-6 IgG positive pre-HSCT. Of which, fourteen patients (14/34, 41.2%) showed positive HHV-6 DNaemia. HHV-6 DNAemia (15/40, 37.5%) was significantly higher among allo (8/12, 66.7%) versus auto (7/28, 25%) HSCT recipients (p = 0.030). Patients with HHV-6 DNAemia developed fever, delayed engraftment and bone marrow suppression in 6/15, 40%, thrombocytopenia (5/15, 33.3%), rash and pneumonitis (2/15, 13.3%), acute GVHD (aGVHD) (1/15, 6.7%). HHV-6 DNAemia ranged from 101 to 102,000 copies/mL. Univariate analysis identified conditioning with busulfan-cyclophosphamide as a significant risk (p = 0.043), while receiving BEAM protocol was a protective factor (p = 0.045). In multivariate analysis, receiving BEAM protocol retained significance (p = 0.040).
Frequent HHV-6 reactivation was detected after HSCT, especially in allo-HSCT recipients with clinical manifestations which could not be otherwise explained. To our best knowledge this is the first study of HHV6 reactivation in HSCT recipients from Egypt. Raising awareness for HHV-6 reactivation manifestations and screening in HSCT recipients could be lifesaving.
免疫功能低下的患者面临潜伏病毒的激活，这增加了发病的风险。
本研究旨在检测异基因（allo）和自体（auto）造血干细胞移植（HSCT）受者中人类疱疹病毒 6（HHV-6）的再激活，并将潜在归因的临床表现与 HHV-6 DNA 血浆水平相关联。
一项前瞻性研究纳入了 2020 年 1 月至 2022 年 6 月期间接受 allo 和 auto-HSCT 的所有（40）名患者。在移植后第 2、4、6 周采集血浆样本进行 HHV-6 血清学和 HHV-6 定量 PCR。记录人口统计学和临床数据。
在 40 名外周血干细胞移植（PBSCT）受者中，34 名（85%）在 HSCT 前 HHV-6 IgG 阳性。其中，14 名患者（14/34，41.2%）显示 HHV-6 DNA 血症阳性。HHV-6 DNAemia（15/40，37.5%）在 allo（8/12，66.7%）与 auto（7/28，25%）HSCT 受者中显著更高（p=0.030）。15 例 HHV-6 DNAemia 患者中有 6 例（6/15，40%）出现发热、延迟植入和骨髓抑制，血小板减少症（5/15，33.3%）、皮疹和肺炎（2/15，13.3%）、急性移植物抗宿主病（aGVHD）（1/15，6.7%）。HHV-6 DNAemia 范围为 101 至 102,000 拷贝/ml。单因素分析发现，使用白消安-环磷酰胺作为预处理是一个显著的风险因素（p=0.043），而接受 BEAM 方案是一个保护因素（p=0.045）。在多因素分析中，接受 BEAM 方案仍然具有显著性（p=0.040）。
在 HSCT 后经常检测到 HHV-6 的再激活，尤其是在 allo-HSCT 受者中，其临床表现无法用其他方式解释。据我们所知，这是埃及首例 HSCT 受者中 HHV6 再激活的研究。提高对 HHV-6 再激活表现和筛查的认识可能对 HSCT 受者的生命至关重要。
