Human herpesvirus-6B infection in pediatric allogenic hematopoietic stem cell transplant patients: Risk factors and encephalitis

Hiroki Miura, Yoshiki Kawamura, Fumihiko Hattori, Makito Tanaka, Kazuko Kudo, Masaru Ihira, Hiroshi Yatsuya, Yoshiyuki Takahashi, Seiji Kojima, Hirotoshi Sakaguchi, Nao Yoshida, Asahito Hama, Tetsushi Yoshikawa

Research output: Contribution to journalArticle

Abstract

Background: Human herpesvirus-6B (HHV-6B) infection after allogenic hematopoietic stem cell transplantation (allo-HSCT) is known to be associated with post-transplant limbic encephalitis in adults. Meanwhile, the association between HHV-6B infection and central nervous system complications remains unclear in pediatric allo-HSCT patients. Methods: In this study, HHV-6B infection was monitored for more than 50 days after HSCT using virus isolation and real-time PCR. Clinical information such as patient background and encephalitis status was collected retrospectively from medical records. Risk factors for HHV-6B infection were determined by the Cox proportional hazards model, and the clinical features of HHV-6B encephalitis in pediatric allo-HSCT patients were elucidated. Results: Human herpesvirus-6B infection was observed in 74 (33.8%) of 219 patients at 3-47 days (median 18, interquartile range 13-20). Risk factors identified in multivariable analysis were hematological malignancy (hazards ratio [HR], 5.0; 95% confidence interval [CI], 2.3/12.5; P <.0001), solid tumor (HR, 4.8; CI, 1.5/16.3; P =.0104), unrelated donor (HR, 2.1; CI, 1.0/4.6; P =.0378), and sex-mismatched donor (HR 1.8; CI, 1.1/3.0; P =.0257). HHV-6B encephalitis occurred in only one of the 219 patients (0.46%); this patient demonstrated the typical clinical course of posterior reversible encephalopathy syndrome. Conclusion: Hematological malignancy, solid tumor, unrelated donor, and sex-mismatched donor were significant risk factors for HHV-6B infection after pediatric allo-HSCT. In pediatric allo-HSCT patients, the incidence of HHV-6B encephalitis was low and the clinical features differed from those in adult patients.

Original languageEnglish
JournalTransplant Infectious Disease
DOIs
Publication statusAccepted/In press - 01-01-2019

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Human Herpesvirus 6
Herpesviridae Infections
Encephalitis
Hematopoietic Stem Cells
Pediatrics
Transplants
Hematopoietic Stem Cell Transplantation
Confidence Intervals
Unrelated Donors
Hematologic Neoplasms
Limbic Encephalitis
Posterior Leukoencephalopathy Syndrome
Tissue Donors
Proportional Hazards Models
Medical Records
Real-Time Polymerase Chain Reaction
Neoplasms
Central Nervous System
Viruses

All Science Journal Classification (ASJC) codes

  • Infectious Diseases
  • Transplantation

Cite this

Miura, Hiroki ; Kawamura, Yoshiki ; Hattori, Fumihiko ; Tanaka, Makito ; Kudo, Kazuko ; Ihira, Masaru ; Yatsuya, Hiroshi ; Takahashi, Yoshiyuki ; Kojima, Seiji ; Sakaguchi, Hirotoshi ; Yoshida, Nao ; Hama, Asahito ; Yoshikawa, Tetsushi. / Human herpesvirus-6B infection in pediatric allogenic hematopoietic stem cell transplant patients : Risk factors and encephalitis. In: Transplant Infectious Disease. 2019.
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title = "Human herpesvirus-6B infection in pediatric allogenic hematopoietic stem cell transplant patients: Risk factors and encephalitis",
abstract = "Background: Human herpesvirus-6B (HHV-6B) infection after allogenic hematopoietic stem cell transplantation (allo-HSCT) is known to be associated with post-transplant limbic encephalitis in adults. Meanwhile, the association between HHV-6B infection and central nervous system complications remains unclear in pediatric allo-HSCT patients. Methods: In this study, HHV-6B infection was monitored for more than 50 days after HSCT using virus isolation and real-time PCR. Clinical information such as patient background and encephalitis status was collected retrospectively from medical records. Risk factors for HHV-6B infection were determined by the Cox proportional hazards model, and the clinical features of HHV-6B encephalitis in pediatric allo-HSCT patients were elucidated. Results: Human herpesvirus-6B infection was observed in 74 (33.8{\%}) of 219 patients at 3-47 days (median 18, interquartile range 13-20). Risk factors identified in multivariable analysis were hematological malignancy (hazards ratio [HR], 5.0; 95{\%} confidence interval [CI], 2.3/12.5; P <.0001), solid tumor (HR, 4.8; CI, 1.5/16.3; P =.0104), unrelated donor (HR, 2.1; CI, 1.0/4.6; P =.0378), and sex-mismatched donor (HR 1.8; CI, 1.1/3.0; P =.0257). HHV-6B encephalitis occurred in only one of the 219 patients (0.46{\%}); this patient demonstrated the typical clinical course of posterior reversible encephalopathy syndrome. Conclusion: Hematological malignancy, solid tumor, unrelated donor, and sex-mismatched donor were significant risk factors for HHV-6B infection after pediatric allo-HSCT. In pediatric allo-HSCT patients, the incidence of HHV-6B encephalitis was low and the clinical features differed from those in adult patients.",
author = "Hiroki Miura and Yoshiki Kawamura and Fumihiko Hattori and Makito Tanaka and Kazuko Kudo and Masaru Ihira and Hiroshi Yatsuya and Yoshiyuki Takahashi and Seiji Kojima and Hirotoshi Sakaguchi and Nao Yoshida and Asahito Hama and Tetsushi Yoshikawa",
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Human herpesvirus-6B infection in pediatric allogenic hematopoietic stem cell transplant patients : Risk factors and encephalitis. / Miura, Hiroki; Kawamura, Yoshiki; Hattori, Fumihiko; Tanaka, Makito; Kudo, Kazuko; Ihira, Masaru; Yatsuya, Hiroshi; Takahashi, Yoshiyuki; Kojima, Seiji; Sakaguchi, Hirotoshi; Yoshida, Nao; Hama, Asahito; Yoshikawa, Tetsushi.

In: Transplant Infectious Disease, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Human herpesvirus-6B infection in pediatric allogenic hematopoietic stem cell transplant patients

T2 - Risk factors and encephalitis

AU - Miura, Hiroki

AU - Kawamura, Yoshiki

AU - Hattori, Fumihiko

AU - Tanaka, Makito

AU - Kudo, Kazuko

AU - Ihira, Masaru

AU - Yatsuya, Hiroshi

AU - Takahashi, Yoshiyuki

AU - Kojima, Seiji

AU - Sakaguchi, Hirotoshi

AU - Yoshida, Nao

AU - Hama, Asahito

AU - Yoshikawa, Tetsushi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Human herpesvirus-6B (HHV-6B) infection after allogenic hematopoietic stem cell transplantation (allo-HSCT) is known to be associated with post-transplant limbic encephalitis in adults. Meanwhile, the association between HHV-6B infection and central nervous system complications remains unclear in pediatric allo-HSCT patients. Methods: In this study, HHV-6B infection was monitored for more than 50 days after HSCT using virus isolation and real-time PCR. Clinical information such as patient background and encephalitis status was collected retrospectively from medical records. Risk factors for HHV-6B infection were determined by the Cox proportional hazards model, and the clinical features of HHV-6B encephalitis in pediatric allo-HSCT patients were elucidated. Results: Human herpesvirus-6B infection was observed in 74 (33.8%) of 219 patients at 3-47 days (median 18, interquartile range 13-20). Risk factors identified in multivariable analysis were hematological malignancy (hazards ratio [HR], 5.0; 95% confidence interval [CI], 2.3/12.5; P <.0001), solid tumor (HR, 4.8; CI, 1.5/16.3; P =.0104), unrelated donor (HR, 2.1; CI, 1.0/4.6; P =.0378), and sex-mismatched donor (HR 1.8; CI, 1.1/3.0; P =.0257). HHV-6B encephalitis occurred in only one of the 219 patients (0.46%); this patient demonstrated the typical clinical course of posterior reversible encephalopathy syndrome. Conclusion: Hematological malignancy, solid tumor, unrelated donor, and sex-mismatched donor were significant risk factors for HHV-6B infection after pediatric allo-HSCT. In pediatric allo-HSCT patients, the incidence of HHV-6B encephalitis was low and the clinical features differed from those in adult patients.

AB - Background: Human herpesvirus-6B (HHV-6B) infection after allogenic hematopoietic stem cell transplantation (allo-HSCT) is known to be associated with post-transplant limbic encephalitis in adults. Meanwhile, the association between HHV-6B infection and central nervous system complications remains unclear in pediatric allo-HSCT patients. Methods: In this study, HHV-6B infection was monitored for more than 50 days after HSCT using virus isolation and real-time PCR. Clinical information such as patient background and encephalitis status was collected retrospectively from medical records. Risk factors for HHV-6B infection were determined by the Cox proportional hazards model, and the clinical features of HHV-6B encephalitis in pediatric allo-HSCT patients were elucidated. Results: Human herpesvirus-6B infection was observed in 74 (33.8%) of 219 patients at 3-47 days (median 18, interquartile range 13-20). Risk factors identified in multivariable analysis were hematological malignancy (hazards ratio [HR], 5.0; 95% confidence interval [CI], 2.3/12.5; P <.0001), solid tumor (HR, 4.8; CI, 1.5/16.3; P =.0104), unrelated donor (HR, 2.1; CI, 1.0/4.6; P =.0378), and sex-mismatched donor (HR 1.8; CI, 1.1/3.0; P =.0257). HHV-6B encephalitis occurred in only one of the 219 patients (0.46%); this patient demonstrated the typical clinical course of posterior reversible encephalopathy syndrome. Conclusion: Hematological malignancy, solid tumor, unrelated donor, and sex-mismatched donor were significant risk factors for HHV-6B infection after pediatric allo-HSCT. In pediatric allo-HSCT patients, the incidence of HHV-6B encephalitis was low and the clinical features differed from those in adult patients.

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