Human herpesvirus 6B encephalitis after allogeneic HSCT: Better understanding the clinical impact, diagnosis, and treatment

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  • 同種造血幹細胞移植後human herpesvirus 6B脳炎：知っておきたいこと

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Abstract

<p> Human herpesvirus 6B (HHV-6B) encephalitis is a significant cause of central nervous complications after allogeneic stem cell transplantation. When a transplant patient shows central nervous system symptoms, the conditions to suggest HHV-6 B encephalitis include a cord blood transplant, HLA-mismatched unrelated transplant, onset at 2-6 weeks after transplantation, symptoms such as memory impairment or dysesthesia, immune reactions, onset under steroid use, and hyponatremia. For such patients, empiric antiviral therapy is recommended. Full dose foscarnet is recommended as the primary treatment when possible. There is no high quality evidence to recommended strategies for cases in which clinical symptoms do not improve well. We recommend an individualized approach that considers the progression and severity of illness as well as patient comorbidities. General strategies for salvage therapy include extending the treatment period, switching to foscarnet or combination therapy for patients treated with ganciclovir, and combination therapy with ganciclovir for patients treated with foscarnet. Combination therapy with foscarnet and ganciclovir may be considered for patients whose consciousness loss or seizures do not improve well.</p>

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