title: The complex relationship between human herpesvirus 6 and acute graft-versus-host disease.
abstract: The most frequent manifestation of human herpesvirus 6 (HHV-6) reactivation after allogeneic hematopoietic stem cell transplantation (HSCT) is febrile rash, raising the question of its relationship with graft-versus-host disease (GVHD). In this retrospective analysis of 365 patients who underwent allogeneic HSCT, HHV-6 reactivation was significantly associated with cord blood transplantation (hazard ratio [HR], 3.20; P < .0001) and the use of unrelated donors (HR, 2.02; P = .008). On multivariate analysis, previous GVHD was a predictive factor for HHV-6 reactivation (HR, 1.80; P = .01), and previous HHV-6 reactivation was a predictive factor for acute GVHD (HR, 1.66; P = .03). Nineteen patients with no pathological evidence of GVHD later developed severe clinical GVHD (grade III-IV), suggesting the role of HHV-6 as a trigger for severe GVHD. Furthermore, 17 patients without histopathological GVHD demonstrated a significant lymphoid infiltrate suggesting "pure" HHV-6-related manifestations, and these patients could have been spared steroid therapy.
authors.affiliation: Hematology/Transplantation, Service d'Hématologie Greffe, AP-HP, Hôpital Saint-Louis, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Pichereau
authors.forename: Kristell
authors.initials: K
authors.lastname: Desseaux
authors.forename: Anne
authors.initials: A
authors.lastname: Janin
authors.forename: Catherine
authors.initials: C
authors.lastname: Scieux
authors.forename: Régis
authors.initials: R
authors.lastname: Peffault de Latour
authors.forename: Aliénor
authors.initials: A
authors.lastname: Xhaard
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.forename: Patricia
authors.initials: P
authors.lastname: Ribaud
authors.forename: Félix
authors.initials: F
authors.lastname: Agbalika
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000821:virology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D015654:Herpesvirus 6, Human / Q000502:physiology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D019349:Roseolovirus Infections / Q000276:immunology*; D014775:Virus Activation / Q000276:immunology; D055815:Young Adult