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Biol Blood Marrow Transplant. 2012 Jan;18(1):141-4. doi: 10.1016/j.bbmt.2011.07.018. Epub 2011 Jul 27.

The complex relationship between human herpesvirus 6 and acute graft-versus-host disease.

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Hematology/Transplantation, Service d'Hématologie Greffe, AP-HP, Hôpital Saint-Louis, Paris, France.


The most frequent manifestation of human herpesvirus 6 (HHV-6) reactivation after allogeneic hematopoietic stem cell transplantation (HSCT) is febrile rash, raising the question of its relationship with graft-versus-host disease (GVHD). In this retrospective analysis of 365 patients who underwent allogeneic HSCT, HHV-6 reactivation was significantly associated with cord blood transplantation (hazard ratio [HR], 3.20; P < .0001) and the use of unrelated donors (HR, 2.02; P = .008). On multivariate analysis, previous GVHD was a predictive factor for HHV-6 reactivation (HR, 1.80; P = .01), and previous HHV-6 reactivation was a predictive factor for acute GVHD (HR, 1.66; P = .03). Nineteen patients with no pathological evidence of GVHD later developed severe clinical GVHD (grade III-IV), suggesting the role of HHV-6 as a trigger for severe GVHD. Furthermore, 17 patients without histopathological GVHD demonstrated a significant lymphoid infiltrate suggesting "pure" HHV-6-related manifestations, and these patients could have been spared steroid therapy.

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