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Human herpesvirus 6B linked to increased mortality among certain HSCT recipients
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Detection of human herpesvirus 6B in bronchoalveolar lavage fluid appeared associated with higher risk for mortality among allogeneic hematopoietic stem cell transplant recipients with lower respiratory tract disease, according to results of a retrospective, single-center study published in Journal of Clinical Oncology.
“Unlike many pulmonary pathogens (such as most respiratory viruses), we have drugs that work well for this virus and with which we have a lot of experience,” Joshua A. Hill, MD, assistant professor of medicine, allergy and infectious diseases at University of Washington and member of the Immunotherapy Integrated Research Center at Fred Hutchinson Cancer Research Center, told HemOnc Today. “Thus, I think it is worth considering treating if human herpesvirus 6B [HHV-6] is found in bronchoalveolar lavage fluid, but this has to be balanced with the risk for side effects from these drugs.”
Lower respiratory tract disease is common after allogeneic HSCT and may contribute to morbidity and mortality.
HHV-6B DNA can be identified in the blood of about 40% of allogeneic HSCT recipients within 100 days of transplantation. It is the most common infectious cause of encephalitis after HSCT.
Hill and colleagues studied whether HHV-6B is a pulmonary pathogen among recipients of allogeneic HSCT who have lower respiratory tract disease.
Researchers used polymerase chain reaction to detect HHV-6B in bronchoalveolar lavage fluid (BALF) samples from 553 patients (49% aged 41-60 years; 58% men; 78% white) who underwent allogeneic HSCT followed by a bronchoalveolar lavage within 100 days of transplantation between 1992 and 2015.
Overall mortality or death from respiratory failure within 100 days after bronchoalveolar lavage served as the study’s primary endpoint.
Results showed 147 (27%) of the patients had HHV-6B DNA in BALF, and that these patients had a significantly increased risk for overall mortality (adjusted HR [aHR] = 2.18; 95% CI, 1.41-3.39) and death from respiratory failure (aHR = 2.5; 95% CI, 1.56-4.01) compared with patients who did not have HHV-6B.
Researchers identified 269 deaths of any cause and 219 deaths of respiratory failure within 100 days of the last bronchoalveolar lavage per patient.
Patients with HHV-6B-positive BALF who received antivirals no more than 3 days before bronchoalveolar lavage had a lower median HHV-6B BALF viral load and lower risk for overall mortality (aHR = 0.42; 95% CI, 0.16-1.1) than patients who did not receive antivirals.
The study’s retrospective nature served as its primary limitation.
“We found that antivirals were associated with improved outcomes, but the study was retrospective and observational, so hard to control for all confounders,” Hill said. “Although a randomized controlled treatment trial would be ideal, it would be challenging to conduct and take a long time. In the interim, these are the best data that we have. Providers should think about testing for HHV-6 by polymerase chain reaction in BALF samples in the appropriate context based on the study design.” – by John DeRosier
For more information:
Joshua A. Hill, MD, can be reached at Fred Hutchinson Cancer Research Center, 1100 Fairview Ave., Seattle, WA 98109; email: jahill3@fredhutch.org.
Disclosures: Hill reports honoraria and travel expenses from Chimerix and consultant/advisory roles with and/or research funding from Amplyx Pharmaceuticals, Karius and Nohla Therapeutics. Please see the study for all other authors’ relevant financial disclosures.
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