Human Herpesvirus Type 6 Reactivation After Haploidentical Hematopoietic Cell Transplantation with Post-transplant Cyclophosphamide and Antithymocyte Globulin: Risk Factors and Clinical Impact

Overview

Journal Clin Hematol Int

Specialty Hematology

Date 2024 May 31

PMID 38817703

Authors

Annalisa Paviglianiti

Tania Maia

Joel-Meyer Gozlan

Eolia Brissot

Florent Malard

Anne Banet

Zoe Van de Wyngaert

Tounes Ledraa

Ramdane Belhocine

Simona Sestili

Antoine Capes

Nicolas Stocker

Agnes Bonnin

Anne Vekhoff

Ollivier Legrand

Mohamad Mohty

Remy Dulery

Affiliations

Soon will be listed here.

Abstract

Human herpesvirus type 6 (HHV6) reactivation after haploidentical hematopoietic cell transplantation (HCT) with post-transplant cyclophosphamide (PT-Cy) has been scarcely studied, especially when antithymocyte globulin (ATG) is added to the graft-versus-host disease (GvHD) prophylaxis. We conducted a retrospective cohort study in 100 consecutive patients receiving haploidentical HCT with PT-Cy. We systematically monitored HHV6 DNA loads in blood samples on a weekly basis using quantitative PCR until day +100. The 100-day cumulative incidence of HHV6 reactivation was 54%. Clinically significant HHV6 infections were rare (7%), associated with higher HHV6 DNA loads, and had favorable outcomes after antiviral therapy. The main risk factor for HHV6 reactivation was a low absolute lymphocyte count (ALC) \< 290/µL on day +30 (68% versus 40%, p = 0.003). Adding ATG to PT-Cy did not increase the incidence of HHV6 reactivation (52% with ATG versus 79% without ATG, p = 0.12). Patients experiencing HHV6 reactivation demonstrated delayed platelet recovery (HR 1.81, 95% CI 1.07-3.05, p = 0.026), higher risk of acute grade II-IV GvHD (39% versus 9%, p \< 0.001) but similar overall survival and non-relapse mortality to the other patients. In conclusion, our findings endorse the safety of combining ATG and PT-Cy in terms of the risk of HHV6 reactivation and infection in patients undergoing haploidentical HCT. Patients with a low ALC on day +30 face a higher risk of HHV6 reactivation and may require careful monitoring.

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