New Rising Infection: Human Herpesvirus 6 Is Frequent in Myeloma Patients Undergoing Autologous Stem Cell Transplantation after Induction Therapy with Bortezomib
Herpesvirus 6 (HHV-6) infection is a common complication during immunosuppression. Its significance for multiple myeloma (MM) patients undergoing autologous stem cell transplantation (ASCT) after treatment with novel agents affecting immune system remains undetermined. Data on 62 consecutive MM patients receiving bortezomib-dexamethasone (VD) ( ; 66%) or thalidomide-dexamethasone (TD) ( , 34%) induction, together with melphalan 200？mg/m2 autograft between 01.2005 and 09.2010, were reviewed. HHV-6 reactivation was diagnosed in patients experiencing postengraftment unexplained fever (PEUF) in the presence of any level of HHHV-6 DNA in blood. There were no statistically significant differences in patient characteristics between the groups, excluding dexamethasone dosage, which was significantly higher in patients receiving TD. Eight patients in TD and 18 in VD cohorts underwent viral screening for PEUF. HHV-6 reactivation was diagnosed in 10 patients of the entire series (16%), accounting for 35% of those screened; its incidence was 19.5% ( ) in the VD group versus 9.5% ( ) in the TD group. All patients recovered without sequelae. In conclusion, HHV-6 reactivation is relatively common after ASCT, accounting for at least a third of PEUF episodes. Further studies are warranted to investigate whether bortezomib has an impact on HHV-6 reactivation development. 1. Introduction Human herpesvirus 6 (HHV-6) is highly prevalent in humans, infecting almost all children during their early childhood [1–4]. Similar to other herpesviruses, it tends to remain dormant in the host tissues, but may reactivate in the presence of immune suppression, resulting in a febrile illness, often accompanied with skin eruption, encephalitis, or pneumonia [5–11]. Immune dysfunction, existing following allogeneic stem cell transplantation (Allo SCT), induced by either immunosuppressive drugs or the development of graft-versus-host disease (GvHD) appears to result in a significant risk of HHV-6 reactivation [12], approaching 33–48% [13–16]. Unlike Allo SCT, autologous stem cell transplantation (ASCT), being associated with mild transient immunodeficiency, has been traditionally considered a less probable cause of HHV-6 reactivation. However, studies exploring this risk in heterogeneous groups of autografted patients reported a similarly high risk for HHV-6 infection [16], suggesting the malignancy itself, and/or the treatment applied preautograft, to contribute to transplant-associated immune impairment. Induction therapy for myeloma has changed dramatically over the last few years and
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