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Paviglianiti, Annalisa; Maia, Tânia; Gozlan, Joël-Meyer; Brissot, Eolia; Malard, Florent; Banet, Anne; Van de Wyngaert, Zoé; Ledraa, Tounes; Belhocine, Ramdane; Sestili, Simona; Capes, Antoine; Stocker, Nicolas; Bonnin, Agnès; Vekhoff, Anne; Legrand, Ollivier; Mohty, Mohamad; Duléry, Rémy

Human herpesvirus type 6 reactivation after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide and antithymocyte globulin: risk factors and clinical impact

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  • Media type: E-Article
  • Title: Human herpesvirus type 6 reactivation after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide and antithymocyte globulin: risk factors and clinical impact
  • Contributor: Paviglianiti, Annalisa; Maia, Tânia; Gozlan, Joël-Meyer; Brissot, Eolia; Malard, Florent; Banet, Anne; Van de Wyngaert, Zoé; Ledraa, Tounes; Belhocine, Ramdane; Sestili, Simona; Capes, Antoine; Stocker, Nicolas; Bonnin, Agnès; Vekhoff, Anne; Legrand, Ollivier; Mohty, Mohamad; Duléry, Rémy
  • imprint: SAABRON PRESS, 2024
  • Published in: Clinical Hematology International
  • Language: English
  • DOI: 10.46989/001c.92525
  • ISSN: 2590-0048
  • Keywords: Hematology ; Health Professions (miscellaneous)
  • Origination:
  • Footnote:
  • Description: <jats:p>Human herpesvirus type 6 (HHV6) reactivation after haploidentical hematopoietic cell transplantation (HCT) with post-transplant cyclophosphamide (PT-Cy) has been scarcely studied, especially when antithymocyte globulin (ATG) is added to the graft-versus-host disease (GvHD) prophylaxis. We conducted a retrospective cohort study in 100 consecutive patients receiving haploidentical HCT with PT-Cy. We systematically monitored HHV6 DNA loads in blood samples on a weekly basis using quantitative PCR until day +100. The 100-day cumulative incidence of HHV6 reactivation was 54%. Clinically significant HHV6 infections were rare (7%), associated with higher HHV6 DNA loads, and had favorable outcomes after antiviral therapy. The main risk factor for HHV6 reactivation was a low absolute lymphocyte count (ALC) &lt; 290/µL on day +30 (68% versus 40%, p = 0.003). Adding ATG to PT-Cy did not increase the incidence of HHV6 reactivation (52% with ATG versus 79% without ATG, p = 0.12). Patients experiencing HHV6 reactivation demonstrated delayed platelet recovery (HR 1.81, 95% CI 1.07-3.05, p = 0.026), higher risk of acute grade II-IV GvHD (39% versus 9%, p &lt; 0.001) but similar overall survival and non-relapse mortality to the other patients. In conclusion, our findings endorse the safety of combining ATG and PT-Cy in terms of the risk of HHV6 reactivation and infection in patients undergoing haploidentical HCT. Patients with a low ALC on day +30 face a higher risk of HHV6 reactivation and may require careful monitoring.</jats:p>
  • Access State: Open Access