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Transferred herpes simplex virus immunity after stem-cell transplantation: clinical implications
W Garrett Nichols1, Michael Boeckh, Rachel A Carter
1Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, University of Washington, 1100 Fairview Avenue N, D3-100, Seattle, WA 98109-4417, USA. gnichols@fhcrc.org
The Journal of Infectious Diseases
|February 25, 2003
Summary
Herpes simplex virus (HSV) reactivation after stem-cell transplantation (SCT) is more frequent and severe when donor and recipient HSV types are mismatched. Donor serological testing can identify high-risk patients for targeted HSV prevention strategies.
Area of Science:
- Infectious Diseases
- Hematology
- Transplantation Immunology
Background:
- Herpes simplex virus (HSV) reactivation is a common complication post-stem cell transplantation (SCT).
- Current acyclovir prophylaxis may not fully prevent HSV reactivation, particularly in specific donor-recipient serological scenarios.
Purpose of the Study:
- To investigate the impact of donor-recipient HSV type concordance on the frequency and severity of HSV infections following SCT.
- To identify risk factors for HSV-related morbidity in SCT recipients.
Main Methods:
- Retrospective analysis of banked serum samples from HSV-seropositive SCT recipients and their donors.
- Serological testing for HSV antibodies to determine type concordance.
- Comparison of HSV infection rates, duration, visceral involvement, and acyclovir resistance between type-discordant and type-concordant pairs.
Main Results:
- HSV-1-positive recipients from HSV-1-negative donors experienced more frequent and longer HSV episodes compared to those from HSV-1-positive donors (27.4% vs. 7.2% on antiviral treatment).
- Type-discordant pairs showed significantly higher rates of HSV-1 visceral infection (9.8% vs. 2.2%) and acyclovir resistance (5.8% vs. 1.8%).
- Multivariable models confirmed these associations, highlighting the increased risk in type-discordant scenarios.
Conclusions:
- Donor-recipient HSV type mismatch is a significant risk factor for increased HSV-related morbidity after SCT.
- Serological screening of donors can identify SCT patients at higher risk for severe HSV infections.
- Consideration of prolonged antiviral prophylaxis or future donor vaccination for high-risk, type-discordant patients is warranted.