title: Herpesvirus-associated central nervous system diseases after allogeneic hematopoietic stem cell transplantation.
abstract: Herpesvirus infections of the central nervous system (CNS) are associated with encephalitis/myelitis and lymphoproliferative diseases in immunocompromised individuals. As of now, data of herpesvirus-associated CNS diseases in transplant recipients is limited. Hence, in this prospective study, we investigated the incidence of herpesvirus-associated CNS diseases and explored the diagnosis of these diseases in 281 allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Herpesvirus-DNA and cerebrospinal fluid (CSF) cells were sampled from 58 recipients with herpesvirus-associated diseases or with unexplainable CNS manifestations. Results showed that 23 patients were diagnosed as herpesvirus-associated CNS diseases, including 15 Epstein-Barr virus (EBV)-associated diseases (4 encephalitis and 11 lymphoproliferative diseases), 5 herpes simplex virus type 1 encephalitis, 2 cytomegalovirus encephalitis/myelitis and 1 varicella zoster virus encephalitis. The median time of diseases onset was 65 (range 22-542) days post-transplantation. The 3-year cumulative incidence of herpesvirus-associated encephalitis/myelitis and post-transplant lymphoproliferative disorder (PTLD) was 6.3% ± 1.9% and 4.1% ± 1.2%, respectively. Of the evaluable cases, CSF cells mainly consisted of CD19(+)CD20(+) B cells (7/11) and had clonal rearrangement of immunoglobulin genes (3/11) in patients with CNS-PTLD. On the contrary, in patients with encephalitis/myelitis, CSF cells were comprised of different cell populations and none of the gene rearrangement was detected. Herpesvirus-associated CNS diseases are common in the early stages of allo-HSCT, wherein EBV is the most frequent causative virus. The immunophenotypic and clonal analysis of CSF cells might be helpful in the differential diagnosis between encephalitis and lymphoproliferative diseases.
authors.affiliation: Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Meiqing
authors.initials: M
authors.lastname: Wu
authors.forename: Fen
authors.initials: F
authors.lastname: Huang
authors.forename: Xinmiao
authors.initials: X
authors.lastname: Jiang
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Fan
authors.forename: Hongsheng
authors.initials: H
authors.lastname: Zhou
authors.forename: Can
authors.initials: C
authors.lastname: Liu
authors.forename: Qianli
authors.initials: Q
authors.lastname: Jiang
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Ke
authors.initials: K
authors.lastname: Zhao
authors.forename: Li
authors.initials: L
authors.lastname: Xuan
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhai
authors.forename: Fuhua
authors.initials: F
authors.lastname: Zhang
authors.forename: Changxin
authors.initials: C
authors.lastname: Yin
authors.forename: Jing
authors.initials: J
authors.lastname: Sun
authors.forename: Ru
authors.initials: R
authors.lastname: Feng
authors.forename: Qifa
authors.initials: Q
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D020805:Central Nervous System Viral Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission*; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006564:Herpesviridae / Q000145:classification / Q000235:genetics; D006566:Herpesviridae Infections / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000473:pathology; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents