HLA-mismatched CD34-selected stem cell transplant complicated by HHV-6 reactivation in the central nervous system

Y. Kawano, T. Miyazaki, T. Watanabe, A. Suzue, S. Kan-Nuki, T. Kagechi, T. Onishi, M. Kaneko, S. Kanamaru, Y. Wakata, R. Nakagawa, K. Suenaga, H. Suzuya, T. Abe, S. Nagahiro, Y. Kuroda, Y. Takaue

Research output: Contribution to journalArticle

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Abstract

We report here a patient who suffered from PCR-confirmed human herpesvirus type 6 (HHV-6) meningoencephalitis after allogeneic purified CD34 + cell transplantation from his HLA-mismatched sibling donor, even though he had been on intense prophylaxis with i.v. ganciclovir (GCV), acyclovir (ACV) and γ-globulin containing a specific antibody against HHV-6. Serological evaluation disclosed that both the donor and recipient had IgG antibody against HHV-6 before transplantation. His blood WBC count started to transiently increase on day 10, and all blood components had decreased by day 20. He then developed a severe headache and high blood pressure, and sporadic abnormal neurological findings including nystagmus and delirium. An analysis of cerebrospinal fluid (CSF) revealed 8 cells/μl, a glucose level of 130 mg/dl and a protein level of 201 mg/dl (normal, 50 mg/dl) on day 26. At the time, HHV-6 was detected only in CSF by a PCR-based method and he was diagnosed as having meningoencephalitis due to the local reactivation of HHV-6. Although he failed to respond to high-dose therapy with ACV (60 mg/kg/day) and γ-globulin, the DNA of this virus disappeared from the CNS upon treatment with GCV (30 mg/kg/day) combined with the intraventricular infusion of α-interferon. His clinical course was further complicated with meningoencephalitis due to staphylococcus epidermidis, and he died of tentorial herniation on day 79 without the recovery of blood components. This experience may indicate that intense prophylaxis to prevent reactivation of HHV-6 in the CNS is essential for the management of such profoundly immunosuppressed patients.

Original languageEnglish
Pages (from-to)787-790
Number of pages4
JournalBone Marrow Transplantation
Volume25
Issue number7
DOIs
Publication statusPublished - Jan 1 2000

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Human Herpesvirus 6
Stem Cells
Central Nervous System
Transplants
Meningoencephalitis
Ganciclovir
Acyclovir
Globulins
Cerebrospinal Fluid
Tissue Donors
Intraventricular Infusions
Polymerase Chain Reaction
DNA Viruses
Staphylococcus epidermidis
Delirium
Antibodies
Cell Transplantation
Interferons
Headache
Siblings

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

Cite this

Kawano, Y., Miyazaki, T., Watanabe, T., Suzue, A., Kan-Nuki, S., Kagechi, T., ... Takaue, Y. (2000). HLA-mismatched CD34-selected stem cell transplant complicated by HHV-6 reactivation in the central nervous system. Bone Marrow Transplantation, 25(7), 787-790. https://doi.org/10.1038/sj.bmt.1702220

HLA-mismatched CD34-selected stem cell transplant complicated by HHV-6 reactivation in the central nervous system. / Kawano, Y.; Miyazaki, T.; Watanabe, T.; Suzue, A.; Kan-Nuki, S.; Kagechi, T.; Onishi, T.; Kaneko, M.; Kanamaru, S.; Wakata, Y.; Nakagawa, R.; Suenaga, K.; Suzuya, H.; Abe, T.; Nagahiro, S.; Kuroda, Y.; Takaue, Y.

In: Bone Marrow Transplantation, Vol. 25, No. 7, 01.01.2000, p. 787-790.

Research output: Contribution to journalArticle

Kawano, Y, Miyazaki, T, Watanabe, T, Suzue, A, Kan-Nuki, S, Kagechi, T, Onishi, T, Kaneko, M, Kanamaru, S, Wakata, Y, Nakagawa, R, Suenaga, K, Suzuya, H, Abe, T, Nagahiro, S, Kuroda, Y & Takaue, Y 2000, 'HLA-mismatched CD34-selected stem cell transplant complicated by HHV-6 reactivation in the central nervous system', Bone Marrow Transplantation, vol. 25, no. 7, pp. 787-790. https://doi.org/10.1038/sj.bmt.1702220
Kawano, Y. ; Miyazaki, T. ; Watanabe, T. ; Suzue, A. ; Kan-Nuki, S. ; Kagechi, T. ; Onishi, T. ; Kaneko, M. ; Kanamaru, S. ; Wakata, Y. ; Nakagawa, R. ; Suenaga, K. ; Suzuya, H. ; Abe, T. ; Nagahiro, S. ; Kuroda, Y. ; Takaue, Y. / HLA-mismatched CD34-selected stem cell transplant complicated by HHV-6 reactivation in the central nervous system. In: Bone Marrow Transplantation. 2000 ; Vol. 25, No. 7. pp. 787-790.
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AU - Kan-Nuki, S.

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AU - Onishi, T.

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AU - Nakagawa, R.

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