伴有人类疱疹病毒6B型（HHV-6B）激活的单倍体相合干细胞移植受者的结局
Outcomes of Haploidentical Stem Cell Transplant Recipients With HHV-6B Reactivation.
作者信息
Handley Guy, Yepes Amanda, Eliassen Eva, Dominguez Gabriel, Pasikhova Yanina, Klinkova Olga, Baluch Aliyah, Febres-Aldana Anthony J, Alsina Melissa, Elmariah Hany, Khimani Farhad, Hansen Doris K, Freeman Ciara L, Jain Michael D, Locke Frederick, Lazaryan Aleksandr, Liu Hein D, Mishra Asmita, Mirza Abu-Sayeef, Nishihori Taiga, Ochoa Leonel, Perez Lia, Pidala Joseph, Puglianini Omar Castaneda, Nieder Michael, Perna Fabiana, Kim Jongphil, Bejanyan Nelli, Faramand Rawan
机构信息
Division of Infectious Disease and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
出版信息
Open Forum Infect Dis. 2024 Sep 26;11(10):ofae564. doi: 10.1093/ofid/ofae564. eCollection 2024 Oct.
BACKGROUND
Human herpesvirus 6B (HHV-6B) frequently reactivates following allogeneic stem cell transplant (alloHCT). Consensus guidelines note that haploidentical alloHCT may represent a high-risk population for which there is little evidence; this warrants further investigation.
METHODS
In this single-center retrospective study, we evaluated 188 consecutive adult patients receiving haploidentical alloHCT between 11/2014 and 11/2020 and compared outcomes between patients with HHV-6B reactivation receiving targeted antiviral therapy and those who were clinically observed.
RESULTS
Of the 58 included patients, 21 (36.2%) received antiviral therapy for HHV-6B reactivation with foscarnet (n = 19) or ganciclovir (n = 2). There were no differences in patient or disease characteristics between treated and observed patients. Treated patients were more likely to have high-level DNAemia (85.7% vs 40.5%; < .001) and had higher peak viral quantitative measurements (median log, 4.65 vs 3.84; < .001). The median time to clearance from plasma (interquartile range) was 13 (7.25-20.00) days for all patients and was not significantly different between groups. There were no differences in episodes of encephalitis, grade III/IV acute graft-vs-host disease (GVHD), or time to neutrophil or platelet engraftment among treated vs observed patients. Day 100 nonrelapse mortality was not significantly different in the multivariate analysis; however, the presence of central nervous system symptoms was strongly associated with worse survival (hazard ratio, 4.11; 95% CI, 1.27-13.34; = .018).
CONCLUSIONS
We did not observe a difference in clinical outcomes between the treated and observed groups of patients with HHV-6B reactivation following haploidentical alloHCT. With the rising use of haploidentical transplant and post-transplant cyclophosphamide GVHD prevention platforms, prospective studies are needed to further characterize the risk and outcomes associated with HHV-6B reactivation and therapy.
背景
人疱疹病毒6B（HHV - 6B）在异基因造血干细胞移植（alloHCT）后常重新激活。共识指南指出，单倍体相合alloHCT可能代表一个高风险人群，但对此几乎没有证据；这值得进一步研究。
方法
在这项单中心回顾性研究中，我们评估了2014年11月至2020年11月期间连续接受单倍体相合alloHCT的188例成年患者，并比较了接受针对HHV - 6B重新激活的靶向抗病毒治疗的患者与临床观察患者的结局。
结果
在纳入的58例患者中，21例（36.2%）因HHV - 6B重新激活接受了抗病毒治疗，使用膦甲酸钠（n = 19）或更昔洛韦（n = 2）。治疗组和观察组患者的患者或疾病特征无差异。治疗组患者更可能出现高水平的病毒血症（85.7%对40.5%；P <.001），且病毒定量测量峰值更高（中位数对数，4.65对3.84；P <.001）。所有患者血浆清除的中位时间（四分位间距）为13（7.25 - 20.00）天，两组之间无显著差异。治疗组与观察组患者在脑炎发作、III/IV级急性移植物抗宿主病（GVHD）或中性粒细胞或血小板植入时间方面无差异。在多因素分析中第100天非复发死亡率无显著差异；然而，中枢神经系统症状的出现与较差的生存率密切相关（风险比，4.11；95%置信区间，1.27 - 13.34；P =.018）。
结论
我们未观察到单倍体相合alloHCT后HHV - 6B重新激活的治疗组和观察组患者在临床结局上存在差异。随着单倍体相合移植和移植后环磷酰胺GVHD预防平台的使用增加，需要进行前瞻性研究以进一步明确与HHV - 6B重新激活及治疗相关的风险和结局。
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