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Viral encephalitis after allogeneic stem cell transplantation: a rare complication with distinct characteristics of different causative agents.
- Source :
-
Haematologica [Haematologica] 2011 Jan; Vol. 96 (1), pp. 142-9. Date of Electronic Publication: 2010 Sep 17. - Publication Year :
- 2011
-
Abstract
- Background: Limited data are available on characteristics of viral encephalitis in patients after allogeneic stem cell transplantation.<br />Design and Methods: We analyzed 2,628 patients after allogeneic stem cell transplantation to identify risk factors and characteristics of viral encephalitis.<br />Results: Viral encephalitis occurred in 32 patients (1.2%, 95% confidence interval 0.8%-1.6%) and was associated with the use of OKT-3 or alemtuzumab for T-cell depletion (P < 0.001) and an increased mortality (P = 0.011) in comparison to patients without viral encephalitis. Detected viruses included human herpesvirus-6 (28%), Epstein-Barr virus (19%), herpes simplex virus (13%), JC virus (9%), varicella zoster virus (6%), cytomegalovirus (6%) and adenovirus (3%). More than one virus was identified in 16% of the patients. The median onset time was 106 days after allogeneic stem cell transplantation for the total group of 32 patients, but onset times were shortest in those with human herpesvirus-6 encephalitis and longest in those with JC virus-associated progressive multifocal leukoencephalopathy. The probability of a sustained response to treatment was 63% (95% confidence interval 44%-82%) with a median survival of 94 (95% confidence interval 36-152) days after onset, but significant variation was found when considering different causative viruses. Patients with herpes simplex virus encephalitis had the most favorable outcome with no encephalitis-related deaths.<br />Conclusions: The use of OKT-3 or alemtuzumab for in vivo T-cell depletion is associated with an increased risk of viral encephalitis after allogeneic stem cell transplantation. Different viruses are frequently associated with distinct characteristics such as onset time, response to treatment and outcome.
- Subjects :
- Adolescent
Adult
Aged
Alemtuzumab
Antibodies, Monoclonal therapeutic use
Antibodies, Monoclonal, Humanized
Antibodies, Neoplasm therapeutic use
Antineoplastic Agents therapeutic use
Antiviral Agents therapeutic use
Child
Child, Preschool
Combined Modality Therapy
Encephalitis, Viral drug therapy
Female
Hematologic Neoplasms therapy
Humans
Immunosuppressive Agents therapeutic use
Infant
Lymphocyte Depletion
Male
Middle Aged
Muromonab-CD3 therapeutic use
Retrospective Studies
Survival Rate
Transplantation, Homologous
Treatment Outcome
Virus Activation
Young Adult
Encephalitis, Viral etiology
Graft vs Host Disease etiology
Hematopoietic Stem Cell Transplantation adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1592-8721
- Volume :
- 96
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Haematologica
- Publication Type :
- Academic Journal
- Accession number :
- 20851868
- Full Text :
- https://doi.org/10.3324/haematol.2010.029876