Human herpesvirus 6 reactivation on the 30th day after allogeneic hematopoietic stem cell transplantation can predict grade 2-4 acute graft-versus-host disease
Background Viral infections and their occult reactivation occasionally cause not only organ damage, but also exacerbation of acute graft‐versus‐host disease (aGVHD), which may increase transplantation‐related mortality synergistically. To determine correlations between viral reactivation and transpl...
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Published in | Transplant infectious disease Vol. 16; no. 3; pp. 440 - 449 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Denmark
Blackwell Publishing Ltd
01.06.2014
Wiley Subscription Services, Inc |
Subjects | |
Online Access | Get full text |
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Summary: | Background
Viral infections and their occult reactivation occasionally cause not only organ damage, but also exacerbation of acute graft‐versus‐host disease (aGVHD), which may increase transplantation‐related mortality synergistically. To determine correlations between viral reactivation and transplantation‐related complications, we performed various viral screening tests on the 30th day after allogeneic hematopoietic stem cell transplantation (HSCT), and assessed the clinical implications.
Patients and methods
Between August 2007 and January 2013, 49 patients (37 men, 12 women) underwent HSCT in our hospital. The stem cell sources were bone marrow (n = 21), peripheral blood (n = 13), and cord blood (n = 15). The presence of cytomegalovirus (CMV), Epstein–Barr virus (EBV), herpesvirus (HHV) 6, and HHV7 in plasma samples prospectively collected from HSCT recipients on day 30 after HSCT was assayed by quantitative polymerase chain reaction, and the correlations with transplantation‐related complications were evaluated.
Results
The positivities of CMV, EBV, HHV6, and HHV7 were 44.9%, 22.4%, 53.1%, and 18.3%, respectively. We analyzed transplantation‐related complications, and a significant correlation was found only between HHV6 and grade 2–4 aGVHD from day 30 to day 100 (P < 0.001). Using a receiver operating characteristic curve, the area under the curve was calculated as 0.86 (95% confidence interval [CI], 0.74–0.98) between the viral load (VL) of HHV6 and grade 2–4 aGVHD. The sensitivity and specificity were 79% and 93%, respectively, when a cutoff value of 87 copies/mL was used. In multivariate analysis using the Fine and Gray proportional hazards model, the clinically determined high‐risk patients (P = 0.004; hazard ratio [HR], 3.69; 95% CI, 1.52–9.00) and the positivity of HHV6 (P < 0.001; HR, 9.957; 95% CI, 2.68–37.06) were extracted as independent risk factors for the cumulative incidence of grade 2–4 aGVHD on or after post‐HSCT day 30. The only risk factor extracted for the elevation of HHV6 VL >87 copies/mL was cord blood transplantation (P = 0.0032; odds ratio, 7.10; 95% CI, 1.98–30.00).
Conclusion
All of the risk factors previously reported to predict severe aGVHD were obtained only during, but not after, HSCT. Our study suggests that the reactivation of HHV6 (≥87 copies/mL) at 30 days after HSCT is a possible predictive marker for grade 2–4 aGVHD on or after post‐HSCT day 30. |
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Bibliography: | ArticleID:TID12229 ark:/67375/WNG-4SBGWC9X-8 istex:02A992497AA2A1E4D24B5BD10D2C8AE2C9EAC873 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1 |
ISSN: | 1398-2273 1399-3062 |
DOI: | 10.1111/tid.12229 |