1. Unexpected High Incidence of Human Herpesvirus-6 Encephalitis after Naive T Cell–Depleted Graft of Haploidentical Stem Cell Transplantation in Pediatric Patients.
- Author
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Sisinni, Luisa, Gasior, Mercedes, de Paz, Raquel, Querol, Sergio, Bueno, David, Fernández, Lucia, Marsal, Julia, Sastre, Ana, Gimeno, Ramon, Alonso, Laura, Badell, Isabel, López-Granados, Eduardo, Torres, Juan, Medina, Laura, Torrent, Montserrat, Diaz de Heredia, Cristina, Escudero, Adela, and Pérez-Martínez, Antonio
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HUMAN herpesvirus-6 , *ENCEPHALITIS , *STEM cell transplantation , *LEUKEMIA in children , *CYTOMEGALOVIRUSES - Abstract
Highlights • CD45RA+ TCD allows the retention of high amounts of donor memory T cells. • HHV-6 can reactivate from donor CD4+ T lymphocytes. • Inflammation of engraftment could facilitate HHV-6 encephalitis. Abstract 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. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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