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.
Cheng
Frankie Wai Tsoi
FW
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
Lee
Vincent
V
Leung
Wing Kwan
WK
Chan
Paul Kay Sheung
PK
Leung
Ting Fan
TF
Shing
Ming Kong
MK
Li
Chi Kong
CK
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