Abstract
Human herpesvirus-6 (HHV-6) is a highly prevalent virus that establishes lifelong latency in human hosts. Symptomatic HHV-6 reactivation rarely occurs in immunocompetent individuals and is best described in immunosuppressed patients such as recipients of bone marrow transplants (BMT). In that setting, HHV-6 reactivation has been associated with fever, rash, pneumonitis, encephalitis, and delayed engraftment. While these complications are well documented in allogeneic transplant, the clinical impact of such reactivation is not well known in autologous BMT. We described a case of HHV-6-associated encephalitis in a previously heavily treated patient with multiple myeloma (MM) following a second autologous BMT, and discuss the need for clinicians to be aware of the potential clinical impact of HHV-6 following autologous BMT in the era of immunomodulatory agents.
Article PDF
Avoid common mistakes on your manuscript.
References
Agut, H, Bonnafous, P, Gautheret-Dejean, A. Laboratory and clinical aspects of human herpesvirus 6 infections. Clin Microbiol Rev 2015;28;313–35.
Pantry, SN, Medveczky, PG. Latency, integration, and reactivation of human herpesvirus-6. Viruses 2017;9;1–12.
Lusso, P, Markham, PD, Tschachler, E, di Marzo Veronese, F, Salahuddin, F, Ablashi, SZ, Ablashi, DV, et al. In vitro cellular tropism of human B-lymphotropic virus (human herpesvirus-6). J Exp Med 1988;167;1659–70.
Ablashi, D, Agut, H, Alvarez-Lafuente, R, Clark, DA, Dewhurst, S, DiLuca, D, et al. Classification of HHV-6A and HHV-6B as distinct viruses. Arch Virol 2014;159;863–70.
Hentrich, M, Oruzio, D, Jager, G, Schlemmer, M, Schleuning, M, Schiel, X, et al. Impact of human herpesvirus-6 after haematopoietic stem cell transplantation. Br J Haematol 2005;128;66–72.
Perissinotti, AJ, Gulbis, A, Shpall, EJ, Howell, J. Characterizing human herpes virus 6 following hematopoietic stem cell transplantation. J Oncol Pharm Pract 2015;21;85–92.
Chevallier, P, Hebia-Fellah, I, Planche, L, Guillaume, T, Bressolette-Bodin, C, Coste-Burel, M, et al. Human herpes virus 6 infection is a hallmark of cord blood transplant in adults and may participate to delayed engraftment: a comparison with matched unrelated donors as stem cell source. Bone Marrow Transplant 2010;45;1204–11.
Kadakia, MP, Rybka, WB, Stewart, JA, Patton, JL, Stamey, FR, Elsawy, M, et al. Human herpesvirus 6: infection and disease following autologous and allogeneic bone marrow transplantation. Blood 1996;87;5341–54.
Yamane, A, Mori, T, Suzuki, S, Mihara, A, Yamazaki, R, Aisa, Y, et al. Risk factors for developing human herpesvirus 6 (HHV-6) reactivation after allogeneic hematopoietic stem cell transplantation and its association with central nervous system disorders. Biol Blood Marrow Transplant 2007;13;100–6.
Yoshikawa, T, Asano, Y, Ihira, M, Suzuki, K, Ohashi, M, Suga, S, et al. Human herpesvirus 6 viremia in bone marrow transplant recipients: clinical features and risk factors. J Infect Dis 2002;185;847–53.
de Pagter, PJ, Schuurman, R, Meijer, E, van Baarle, D, Sanders, EA, Boelens, JJ. Human herpesvirus type 6 reactivation after haematopoietic stem cell transplantation. J Clin Virol 2008;43;361–6.
Zerr, DM, Corey, L, Kim, HW, Huang, ML, Nguy, L, Boeckh, M. Clinical outcomes of human herpesvirus 6 reactivation after hematopoietic stem cell transplantation. Clin Infect Dis 2005;40;932–40.
Ogata, M, Satou, T, Kadota, J, Saito, N, Yoshida, T, Okumura, H, et al. Human herpesvirus 6 (HHV-6) reactivation and HHV-6 encephalitis after allogeneic hematopoietic cell transplantation: a multicenter, prospective study. Clin Infect Dis 2013;57;671–81.
Inazawa, N, Hori, T, Nojima, M, Saito, M, Igarashi, K, Yamamoto, M, et al. Virus reactivations after autologous hematopoietic stem cell transplantation detected by multiplex PCR assay. J Med Virol 2017;89;358–62.
Moschettini, D, Galieni, P, Valensin, PE, Laszlo, D, Scalia, G, Tozzi, M, et al. Human herpesvirus 6 infection in autologous bone marrow transplant recipients: a prospective study. J Med Virol 2000;60;39–42.
Wilborn, F, Brinkmann, V, Schmidt, CA, Neipel, F, Gelderblom, H, Siegert, W. Herpesvirus type 6 in patients undergoing bone marrow transplantation: serologic features and detection by polymerase chain reaction. Blood 1994;83;3052–8.
Horowitz, N, Oren, I, Lavi, N, Zuckerman, T, Benyamini, N, Kra-Oz, Z, et al. New rising infection: human herpesvirus 6 is frequent in myeloma patients undergoing autologous stem cell transplantation after induction therapy with bortezomib. Bone Marrow Res 2012;2012;409765.
Balsat, M, Pillet, S, Tavernier, E, Cacheux, V, Escuret, V, Molucon-Chabrot, C, et al. Human herpesvirus 6 infection after autologous stem cell transplantation: a multicenter prospective study in adult patients. J Infect 2019;79;36–42.
Bommer, M, Pauls, S, Greiner, J. Challenging complications of treatment—human herpes virus 6 encephalitis and pneumonitis in a patient undergoing autologous stem cell transplantation for relapsed Hodgkin’s disease: a case report. Virol J 2009;6;111.
Salahuddin, SZ, Ablashi, DV, Markham, PD, Josephs, SF, Sturzenegger, S, Kaplan, M, et al. Isolation of a new virus, HBLV, in patients with lymphoproliferative disorders. Science 1986; 234;596–601.
Razonable, RR, Lautenschlager, I. Impact of human herpes virus 6 in liver transplantation. World J Hepatol 2010;2;345–53.
El-Jawahri, AR, Schaefer, PW, El Khoury, JB, Martinez-Lage, M. Case 5-2018: a 63-year-old man with confusion after stem-cell transplantation. N Engl J Med 2018;378;659–69.
Hill, JA, Koo, S, Guzman Suarez, BB, Ho, VT, Cutler, C, Koreth, J, et al. Cord-blood hematopoietic stem cell transplant confers an increased risk for human herpesvirus-6-associated acute limbic encephalitis: a cohort analysis. Biol Blood Marrow Transplant 2012;18;1638–48.
Imbert-Marcille, BM, Tang, XW, Lepelletier, D, Besse, B, Moreau, P, Billaudel, S, et al. Human herpesvirus 6 infection after autologous or allogeneic stem cell transplantation: a single-center prospective longitudinal study of 92 patients. Clin Infect Dis 2000;31;881–6.
Galieni, P, Moschettini, D, Donati, D, Tozzi, M, Valensin, PE, Lauria, F. Long-term follow-up of human herpes virus 6 infection in autologous bone marrow transplant recipients. Haematologica 2001;86;782–3.
Kotla, V, Goel, S, Nischal, S, Heuck, C, Vivek, K, Das, B, et al. Mechanism of action of lenalidomide in hematological malignancies. J Hematol Oncol 2009;2;36.
Nencioni, A, Garuti, A, Schwarzenberg, K, Cirmena, G, Dal Bello, G, Rocco, I, et al. Proteasome inhibitor-induced apoptosis in human monocyte-derived dendritic cells. Eur J Immunol 2006;36;681–9.
Kim, JW, Min, CK, Mun, YC, Park, Y, Kim, BS, Nam, SH, et al. Varicella-zoster virus-specific cell-mediated immunity and herpes zoster development in multiple myeloma patients receiving bortezomib- or thalidomide-based chemotherapy. J Clin Virol 2015;73;64–9.
Onaka, T, Yonezawa, A. Herpes zoster duplex bilateralis in bortezomib-based chemotherapy. Blood Res 2016;51;155.
Author information
Authors and Affiliations
Corresponding author
Additional information
Peer review under responsibility of the International Academy for Clinical Hematology
Rights and permissions
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).
About this article
Cite this article
Azzi, J.M., Park, D., Abdul-Hay, M. et al. Human Herpes Virus-6 Encephalitis Following Autologous Blood and Marrow Transplant. Clin Hematol Int 2, 32–34 (2020). https://doi.org/10.2991/chi.d.191123.001
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.2991/chi.d.191123.001