1. Human herpesvirus 6 reactivation and disease are infrequent in chimeric antigen receptor T-cell therapy recipients.
- Author
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Kampouri E, Krantz EM, Xie H, Ibrahimi SS, Kiem ES, Sekhon MK, Liang EC, Cowan AJ, Portuguese A, Green DJ, Albittar A, Huang JJ, Gauthier J, Pérez-Osorio AC, Jerome KR, Zerr DM, Boeckh MJ, and Hill JA
- Subjects
- Humans, Male, Female, Middle Aged, Adult, Aged, Prospective Studies, Retrospective Studies, Young Adult, Incidence, Herpesvirus 6, Human immunology, Roseolovirus Infections immunology, Roseolovirus Infections virology, Roseolovirus Infections therapy, Roseolovirus Infections diagnosis, Receptors, Chimeric Antigen immunology, Virus Activation immunology, Immunotherapy, Adoptive methods, Immunotherapy, Adoptive adverse effects
- Abstract
Abstract: Human herpesvirus 6B (HHV-6B) reactivation and disease are increasingly reported after chimeric antigen receptor (CAR) T-cell therapy (CARTx). HHV-6 reactivation in the CAR T-cell product was recently reported, raising questions about product and patient management. Because of overlapping manifestations with immune effector cell-associated neurotoxicity syndrome, diagnosing HHV-6B encephalitis is challenging. We provide 2 lines of evidence assessing the incidence and outcomes of HHV-6B after CARTx. First, in a prospective study with weekly HHV-6B testing for up to 12 weeks after infusion, HHV-6B reactivation occurred in 8 of 89 participants; 3 had chromosomally integrated HHV-6 and were excluded, resulting in a cumulative incidence of HHV-6B reactivation of 6% (95% confidence interval [CI], 2.2-12.5). HHV-6B detection was low level (median peak, 435 copies per mL; interquartile range, 164-979) and did not require therapy. Second, we retrospectively analyzed HHV-6B detection in the blood and/or cerebrospinal fluid (CSF) within 12 weeks after infusion in CARTx recipients. Of 626 patients, 24 had symptom-driven plasma testing, with detection in 1. Among 34 patients with CSF HHV-6 testing, 1 patient had possible HHV-6 encephalitis for a cumulative incidence of 0.17% (95% CI, 0.02-0.94), although symptoms improved without treatment. Our data demonstrate that HHV-6B reactivation and disease are infrequent after CARTx. Routine HHV-6 monitoring is not warranted., (© 2024 American Society of Hematology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)
- Published
- 2024
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