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- Title
Foscarnet against human herpesvirus (HHV)-6 reactivation after allo-SCT: breakthrough HHV-6 encephalitis following antiviral prophylaxis.
- Authors
Ogata, M; Satou, T; Inoue, Y; Takano, K; Ikebe, T; Ando, T; Ikewaki, J; Kohno, K; Nishida, A; Saburi, M; Miyazaki, Y; Ohtsuka, E; Saburi, Y; Fukuda, T; Kadota, J
- 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 DNA104 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.
- Subjects
JAPAN; HUMAN herpesvirus-6; ENCEPHALITIS; COHORT analysis; CORD blood; DNA; DENTAL prophylaxis; CANCER patients
- Publication
Bone Marrow Transplantation, 2013, Vol 48, Issue 2, p257
- ISSN
0268-3369
- Publication type
Article
- DOI
10.1038/bmt.2012.121