ArticleBlood advances2026
Frequency, kinetics, and clinical significance of HHV-6 DNAemia after PTCy-based hematopoietic cell transplant.
Article in Blood advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
abstractThe clinical significance of human herpesvirus 6 (HHV-6) after allogeneic hematopoietic cell transplant (HCT) is debated. We prospectively collected weekly whole-blood HHV-6 in 217 posttransplantation cyclophosphamide (PTCy)-based HCT recipients. Overall, 149 patients (69%) had HHV-6 detected, at a median of 21 days after HCT; in 63 (29%) patients, HHV-6 DNAemia spiked to ≥4 × log10 copies per mL (high-level HHV-6 DNAemia) at median day +27. Hematologic malignancy, myeloablative conditioning, HLA-partially mismatched donor, marrow graft, PTCy dose, and sirolimus use were univariates associated with high-level HHV-6 DNAemia. All spikes precipitously declined spontaneously, but after initial decline, 27% persisted at ≥3 × log10 copies per mL for >1 month. Those with HHV-6 spikes had lower day +28 CD4+ T-cell counts. During initial spikes, there was a strong correlation between plasma and whole-blood HHV-6 DNAemia. By contrast, in patients with HHV-6 persisting for >1 month, HHV-6 was predominantly found within CD4+ T cells but not in plasma. Only 1 patient developed HHV-6-associated encephalitis. High-level HHV-6 DNAemia was associated with significantly increased rates of otherwise unexplained fever (35% vs 21% in patients without high-level HHV-6 DNAemia), rash (27% vs 12%), transaminitis (52% vs 27%), and gastrointestinal symptoms (23% vs 7%), as well as increased risk of acute (36% vs 18%) and moderate-to-severe chronic graft-versus-host disease (GVHD; 22% vs 8%). HHV-6 detection occurs frequently in PTCy recipients but infrequently leads to classic HHV-6-related disease (encephalitis), although it associates with various self-limited clinical symptoms, may play a role in shaping immune reconstitution, and may serve as a marker for increased GVHD risk.
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