Temporal relationship between HHV 6 and graft vs host disease in a patient after haplo-identical SCT and severe T-cell depletion.

摘要

In haplo-identical SCT (haploSCT), the risk of GVHD is virtually nil because of the necessity of T-cell depletion. In HLA-identical SCT human herpes virus type 6 (HHV6) reactivation is correlated with the occurrence of GVHD, but time-correlations between HHV6 and GVHD lack and reports are contradictory. In this report we describe a striking temporal relationship between HHV6 reactivation and GVHD in a patient after extensive T-cell depletion haploSCT.A 22-year-old, previously healthy male was diagnosed with AML without cytogenetic or molecular abnormalities (World Health Organization classification AML, not otherwise specified). Treatment was started containing cytarabine 200mg/m2 (7 days) and idarubicin 12mg/m2 (3 days). The patient had a refractory clone. Reinduction with cytarabine 2000 mg/m2 (6 days) and amsacrine 120mg/m2 (3 days) resulted in CR. Because of the high risk of early relapse, absence of an HLA-identical sibling and susceptibility to NK allo-reactivity (donor but not patient HLA-C2 positive and KIR2DL1 present in the donors genome), it was decided to perform a haploSCT.