title: Preemptive therapy of human herpesvirus-6 encephalitis with foscarnet sodium for high-risk patients after hematopoietic SCT.
abstract: Human herpesvirus-6 (HHV-6) is a major cause of limbic encephalitis with a dismal prognosis after allogeneic hematopoietic SCT (HSCT). A prospective, multicenter study was conducted to assess the safety and efficacy of preemptive therapy with foscarnet sodium (PFA) for the prevention of HHV-6 encephalitis. Plasma HHV-6 DNA was measured thrice weekly from day 7 until day 36 after umbilical cord blood transplantation (UCBT) or HSCT from HLA-haploidentical relatives. PFA, 90 mg/kg/day, was started when HHV-6 DNA exceeded 5 × 10(2) copies/mL. Mild and transient adverse events were associated with PFA in 7 of 8 patients. Twelve of 15 UCBT recipients became positive for HHV-6 DNAemia, defined by greater than 1 × 10(2) copies/mL of HHV-6 DNA in plasma. The virus exceeded 5 × 10(2) copies/mL in seven patients, whereas none of the five HLA-haploidentical HSCT recipients became positive. One patient developed mild limbic encephalitis just after initial PFA administration. Preemptive PFA therapy is safe, but as HHV-6 DNAemia can abruptly develop before neutrophil engraftment in UCBT recipients, prophylactic PFA administration from day 7 or earlier after UCBT may be needed.
authors.affiliation: Department of Cellular Transplantation Biology, Division of Cancer Medicine, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ishiyama
authors.forename: T
authors.initials: T
authors.lastname: Katagiri
authors.forename: T
authors.initials: T
authors.lastname: Hoshino
authors.forename: T
authors.initials: T
authors.lastname: Yoshida
authors.forename: M
authors.initials: M
authors.lastname: Yamaguchi
authors.forename: S
authors.initials: S
authors.lastname: Nakao
mesh_terms: D000293:Adolescent; D000328:Adult; D018890:Chemoprevention / Q000379:methods; D004279:DNA, Viral / Q000097:blood; D004660:Encephalitis / Q000209:etiology / Q000517:prevention & control* / Q000821:virology*; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D015654:Herpesvirus 6, Human / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011292:Premedication / Q000379:methods*; D019349:Roseolovirus Infections / Q000517:prevention & control; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D017245:Foscarnet