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Unexpected High Incidence of Human Herpesvirus-6 Encephalitis after Naive T Cell–Depleted Graft of Haploidentical Stem Cell Transplantation in Pediatric Patients

2018; Elsevier BV; Volume: 24; Issue: 11 Linguagem: Inglês

10.1016/j.bbmt.2018.07.016

1523-6536

Luisa Sisinni, Mercedes Gasior Kabat, Raquel de Paz, Sergio Querol, David Bueno, Lucía Fernández, Júlia Marsal, Ana Méndez‐Echevarría, Ramón Gimeno, Laura Alonso, Isabel Badell, Eduardo López‐Granados, Juan Manuel Torres, Laura Medina, Montserrat Torrent, Cristina Díaz de Heredia, Adela Escudero, Antonio Pérez‐Martínez,

Polyomavirus and related diseases

The CD45RA T cell depletion (TCD) method has been used to deplete naive T cells, preventing graft-versus-host disease (GVHD) but preserving memory cells, providing immediate functional T cells with anti-infection, antileukemia, and antirejection effects. We describe a series of 25 consecutive high-risk patients with leukemia who received haploidentical hematopoietic stem cell transplantation (haplo-HSCT) with CD45RA TCD. Each patient received 2 cell products: 1 created by CD34 positive selection and the other through CD45RA depletion from the CD34 negative fraction by a CliniMACS device. CD45RA-depleted haplo-HSCT was well tolerated, with rapid engraftment and low risk of severe acute GVHD and chronic GVHD. Although this treatment achieved a good control of viral reactivations, such as cytomegalovirus and adenovirus, we observed an unexpectedly high rate of limbic encephalitis due to human herpesvirus-6 (HHV-6; 8 cases). Characteristically, the infection appeared early in almost all patients, just after the engraftment. Although no patient died from encephalitis, 1 patient showed neuropsychological sequelae, and another experienced secondary graft failure just after the HHV-6 reactivation.