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. 2024 Sep 26;11(10):ofae564.
doi: 10.1093/ofid/ofae564. eCollection 2024 Oct.

Outcomes of Haploidentical Stem Cell Transplant Recipients With HHV-6B Reactivation

Guy Handley  1   2 , Amanda Yepes  3 , Eva Eliassen  4 , Gabriel Dominguez  4 , Yanina Pasikhova  3 , Olga Klinkova  2 , Aliyah Baluch  2 , Anthony J Febres-Aldana  2 , Melissa Alsina  5 , Hany Elmariah  5 , Farhad Khimani  5 , Doris K Hansen  5 , Ciara L Freeman  5 , Michael D Jain  5 , Frederick Locke  5 , Aleksandr Lazaryan  5 , Hein D Liu  5 , Asmita Mishra  5 , Abu-Sayeef Mirza  5 , Taiga Nishihori  5 , Leonel Ochoa  5 , Lia Perez  5 , Joseph Pidala  5 , Omar Castaneda Puglianini  5 , Michael Nieder  5 , Fabiana Perna  5 , Jongphil Kim  6 , Nelli Bejanyan  5 , Rawan Faramand  5
Affiliations

Outcomes of Haploidentical Stem Cell Transplant Recipients With HHV-6B Reactivation

Guy Handley et al. Open Forum Infect Dis. .

Abstract

Background: Human herpesvirus 6B (HHV-6B) frequently reactivates following allogeneic stem cell transplant (alloHCT). Consensus guidelines note that haploidentical alloHCT may represent a high-risk population for which there is little evidence; this warrants further investigation.

Methods: In this single-center retrospective study, we evaluated 188 consecutive adult patients receiving haploidentical alloHCT between 11/2014 and 11/2020 and compared outcomes between patients with HHV-6B reactivation receiving targeted antiviral therapy and those who were clinically observed.

Results: Of the 58 included patients, 21 (36.2%) received antiviral therapy for HHV-6B reactivation with foscarnet (n = 19) or ganciclovir (n = 2). There were no differences in patient or disease characteristics between treated and observed patients. Treated patients were more likely to have high-level DNAemia (85.7% vs 40.5%; P < .001) and had higher peak viral quantitative measurements (median log10, 4.65 vs 3.84; P < .001). The median time to clearance from plasma (interquartile range) was 13 (7.25-20.00) days for all patients and was not significantly different between groups. There were no differences in episodes of encephalitis, grade III/IV acute graft-vs-host disease (GVHD), or time to neutrophil or platelet engraftment among treated vs observed patients. Day 100 nonrelapse mortality was not significantly different in the multivariate analysis; however, the presence of central nervous system symptoms was strongly associated with worse survival (hazard ratio, 4.11; 95% CI, 1.27-13.34; P = .018).

Conclusions: We did not observe a difference in clinical outcomes between the treated and observed groups of patients with HHV-6B reactivation following haploidentical alloHCT. With the rising use of haploidentical transplant and post-transplant cyclophosphamide GVHD prevention platforms, prospective studies are needed to further characterize the risk and outcomes associated with HHV-6B reactivation and therapy.

Keywords: HHV6; allogeneic hematopoietic stem cell transplant; haploidentical; post-transplant cyclophosphamide; viral reactivations.

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Conflict of interest statement

Potential conflicts of interest. G.H., Y.P., E.E., G.D., Y.P., O.K., A.B., A.J.F., F.K., A.S.M., L.O., L.P., M.N., F.P., and J.K. report no conflicts of interest. M.A. reports a consulting or advisory role with BMS and Janssen and speakers’ bureau membership with Janssen Oncology; H.E. reports a consulting or advisory role with Sanofi and Humanigen and research funding from BMS; D.K.H. reports a consulting or advisory role with BMS, Janssen, Pfizer, and Karyopharm and research funding from Janssen and Karyopharm; C.L.F. reports a consulting or advisory role with BMS, Seattle Genetics, Celgene, AbbVie, Sanofi, Incyte, Amgen, ONK Therapeutics, and Janssen and has received research funding from BMS, Janssen, and Roche/Genentech; M.D.J. reports a consultancy or advisory role for Kite/Gilead and Myeloid Therapeutics and received research funding from Kite/Gilead, Incyte, and Loxo@Lilly; F.L. reports a consulting or advisory role with Novartis, Celgene, Calibr, Alimera Sciences, Gerson Lehrman Group, EcoR1 Capital, Amgen, Bluebird Bio, BMS, Iovance Biotherapeutics, Legend Biotech, Cowen, Kite, a Gilead company, Umoja Biopharma, Takeda, Sana Biotechnology, Daiichi Sankyo/UCB Japan, Bristol Myers Squibb/Celgene, Janssen, A2 Biotherapeutics, Miltenyi Biotec, Caribou Biosciences, Takeda, and Umoja Biopharma and research funding from Kite, a Gilead company (Inst), Alimera Sciences (Inst), Novartis (Inst), Bluebird Bio (Inst), and Bristol Myers Squibb/Celgene (Inst); A.L. provides consultancy fees from, receives honoria from, and is a member of the scientific advisory board for Sanofi; H.D.L. has a membership on the board of directors of the advisory committee at BioLineRx; A.M. reports research funding from Novartis; T.N. reports research funding from Novartis and Karyopharm and is on the speakers’ bueau at Medexus Pharmaceuticals; J.P. reports a consulting and advisory board membership with Syndax, CTI Biopharma, Amgen, Regeneron, and Incyte and has received clinical trial funding from Novartis, Amgen, Takeda, Janssen, Johnson and Johnson, Pharmacyclics, AbbVie, CTI Biopharma, and BMS; O.C. reports a consulting or advisory role for Legend Biotech USA Inc. and Bristol Myers Squibb and being a member of the speakers’ bureau for Bristol Myers Squibb; N.B. provides consulting for and receives research funding from Orca Bio, CareDx Pharma, CRISPR, Sanofi, CTI BioPharma, Medexus Pharmaceuticals, and Magenta; R.F. receives research funding from Gilead.

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