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Virus-specific immunotherapy for transplant patients with primary immune deficiencies

In All, Immune Dysfunction, Transplant Complications, Treatments - Adoptive T cell by Kristin Loomis

A group from Baylor College of Medicine reviewed the efficacy of treating viral infections in transplant patients with primary immunodeficiencies using their viral-specific T lymphocytes. A total of 36 patients were treated with these immunotherapy infusions before or after undergoing hematopoietic stem cell transplantation, and a complete or partial antiviral response were seen in 86% of patients with CMV, 76% of patients with EBV and all patients with adenovirus or HHV-6.

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Stanford uses non-invasive new assay to detect occult infections including HHV-6 after lung transplantion

In All, Heart Disease, Transplant Complications by Kristin Loomis

Researchers from Stanford University successfully used circulating cell-free DNA to identify infections in lung transplants that can often be found only with a more invasive transbronchial biopsy. This hypothesis free approach led to find HHV-6 & 7 at high levels in patients with infections, even though these viruses are not generally considered lung pathogens.

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HHV-6 myocarditis, pericarditis following transplantation

In All, Heart Disease, Transplant Complications by Kristin Loomis

A hematology group in Australia reported a case of biopsy-proven HHV-6 myocarditis post-hematopoietic stem cell transplantation (HSCT). he post-mortem exam confirmed dilated cardiomyopathy and focal changes consistent with viral myocarditis and cardiac tissue was positive for HHV-6 DNA by nested and quantitative PCR. Separately, A Japanese group reported a worman who developed pericarditis with over 10,000 copies/ml of HHV-6 DNA in the pericardial fluid, after a cord blood transplant.

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HHV-6 the only pathogen identified in early post-transplant CNS dysfunction

In All, CNS Dysfunction, Transplant Complications by Kristin Loomis

A group from Sapporo Medical University studied 105 post HSCT patients and determined that 7 developed CNS dysfunction in the first 42 days after transplant. Six out of the 7 were positive for HHV-6, but none of the other 12 pathogens tested. Four patients (3.8%) were diagnosed with HHV-6 encephalitis. The group used a qualitative multiplex PCR and then used a quantitative PCR to confirm the results.

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Delirium associated with HHV-6B reactivation in cord blood transplant patients: time for an antiviral prophylaxis trial?

In All, Chronic Fatigue Syndrome, Cognitive Dysfunction, Encephalitis & Encephalopathy, Showcase, Transplant Complications by Kristin Loomis

A prospective study authored by Joshua Hill and Danielle Zerr determined that higher than average HHV-6B DNA levels increased the odds of developing delirium after cord blood transplantation (CBT) by almost three fold. Patients with DNA loads in the top quartile had a 4.5 fold increase in delirium.

Multiplex PCR; HHV-6 loads higher with steroids

In All, Transplant Complications by hhv6foundation

A large-scale multiplex PCR assay developed by a team in Japan was used to study 13 DNA viruses in 105 allogenic hematopoietic stem cell transplant patients. Their findings identify HHV-6 as the most common virus (found in 60% of all patients), and also as the only virus tied to the onset of acute GVHD (p=0.016). Interestingly, HHV-6 reactivation was associated with a more severe stage of skin but not liver or gut aGVHD (P=0.005). In addition, patients treated with steroids had a significantly higher risk of HHV-6 reactivation (p=0.027) and cord blood transplant patients were 10.4x more likely to reactivate with HHV-6. The authors looked at the association of HHV-6 reactivation in the absence of GVHD, and found that it …

Expert Opinion: Dr. Louis Flamand calls for screening of transplant organs and cells for ciHHV-6 status

In All, ciHHV-6, Transplant Complications by hhv6foundation

Dr. Flamand, a professor and molecular virologist at Université Laval in Quebec city, has written an editorial calling for screening of organ donors for ciHHV-6 status and careful monitoring of recipients of ciHHV-6 donor tissues for signs of active HHV-6 infection and HHV-6 antigen-induced immune rejection. Flamand also questions whether solid organs and stem cells derived from persons with ciHHV-6 should be used in transplantation.