HHV-6 encephalitis in pediatric unrelated umbilical cord transplantation: a role for ganciclovir prophylaxis?
The role of ganciclovir as HHV-6 prophylaxis in unrelated HSCT setting remains controversial. We performed an eight-yr retrospective review of patients received unrelated HSCT from January 2000 to September 2008. From January 2002, ganciclovir prophylaxis 5 mg/kg twice daily for seven days for all unrelated HSCT before transplant was adopted. The prevalence of HHV-6 encephalitis was studied before and after the change in policy. Fifty-four unrelated HSCT were performed from January 2000 to September 2008. Four cases (7.4%) of HHV-6 encephalitis were diagnosed. All of them were due to variant B infection. Two cases out of 16 cases (12.5%) were diagnosed before adoption of the policy; two cases out of 38 cases (5.3%) were diagnosed afterward. All of them were unrelated UCB transplant recipients. They were all seropositive to HHV-6 before transplant. Two cases complicated with significant residual neurological deficit and refractory seizure. The other two cases died of other transplant-related mortalities. We conclude that HHV-6 encephalitis is still a rare complication of unrelated HSCT and may be more common in unrelated UCB transplant. Routine use of ganciclovir as HHV-6 prophylaxis in all unrelated HSCT recipients may not be justified but may have a role in unrelated UCB transplant.
Department of Pediatrics, Prince of Wales Hospital, and Department of Microbiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. frankiecheng@cuhk.edu.hk
Frankie Wai Tsoi
FW
Cheng
Vincent
V
Lee
Wing Kwan
WK
Leung
Paul Kay Sheung
PK
Chan
Ting Fan
TF
Leung
Ming Kong
MK
Shing
Chi Kong
CK
Li
D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D036101:Cord Blood Stem Cell Transplantation; D018792:Encephalitis, Viral / Q000188:drug therapy* / Q000517:prevention & control / Q000821:virology*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D015654:Herpesvirus 6, Human; D006801:Humans; D007223:Infant; D008297:Male; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D019349:Roseolovirus Infections / Q000188:drug therapy* / Q000517:prevention & control; D016896:Treatment Outcome
D000998:Antiviral Agents; D015774:Ganciclovir