title: Foscarnet against human herpesvirus (HHV)-6 reactivation after allo-SCT: breakthrough HHV-6 encephalitis following antiviral prophylaxis.
abstract: High incidences of human herpesvirus (HHV)-6 encephalitis have recently been reported from several Japanese SCT centers. To evaluate the effect of low-dose foscarnet (PFA) in preventing HHV-6 infection among recipients of unrelated BM or cord blood (CB), we examined consecutive cohorts without prophylaxis against HHV-6 (cohort 1, n=51) and with PFA prophylaxis (cohort 2, PFA 50 mg/kg/day for 10 days after engraftment, n=67). Plasma real-time PCR assay was performed weekly. High-level reactivation defined as HHV-6 DNA > or =10(4) copies/mL by day 70 was the primary endpoint. No significant reduction of high-level reactivation was seen in cohort 2 (19.4%) compared with cohort 1 (33.8%, P=0.095). A trend was identified toward fewer high-level HHV-6 reactivations in cohort 2 among recipients of unrelated BM (P=0.067), but no difference in incidence was observed among CB recipients (P=0.75). Breakthrough HHV-6 encephalitis occurred following PFA prophylaxis in three patients, and incidence of HHV-6 encephalitis did not differ between cohort 1 (9.9%) and cohort 2 (4.5%, P=0.24). In conclusion, 50 mg/kg/day of PFA does not effectively suppress HHV-6 reactivation and cannot prevent all cases of HHV-6 encephalitis. To effectively prevent HHV-6 encephalitis, alternative approaches based on the pathogenesis of HHV-6 encephalitis will probably be required.
authors: Department of Hematology, Oita University Hospital, Oita, Japan.
authors: M
authors: M
authors: Ogata
authors: T
authors: T
authors: Satou
authors: Y
authors: Y
authors: Inoue
authors: K
authors: K
authors: Takano
authors: T
authors: T
authors: Ikebe
authors: T
authors: T
authors: Ando
authors: J
authors: J
authors: Ikewaki
authors: K
authors: K
authors: Kohno
authors: A
authors: A
authors: Nishida
authors: M
authors: M
authors: Saburi
authors: Y
authors: Y
authors: Miyazaki
authors: E
authors: E
authors: Ohtsuka
authors: Y
authors: Y
authors: Saburi
authors: T
authors: T
authors: Fukuda
authors: J
authors: J
authors: Kadota
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D018792:Encephalitis, Viral / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control / Q000821:virology; D017245:Foscarnet / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods*; D015654:Herpesvirus 6, Human / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D019349:Roseolovirus Infections / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control / Q000821:virology; D014184:Transplantation, Homologous; D014775:Virus Activation / Q000187:drug effects; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D017245:Foscarnet