Antineoplastics
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Reactions 1500, p8 - 10 May 2014 Antineoplastics Human herpes virus 6 reactivation: 2 case reports A boy and a girl, with class 3 β-thalassaemia major, developed human herpes virus 6 (HHV-6) reactivation after administration of alemtuzumab, fludarabine, melphalan and thiotepa before haematopoietic stem cell transplantation (HSCT) as immunosuppressive and myeloablative therapy [routes and outcomes not stated]. Both the patients were HHV-6 IgG positive prior to transplant. A 5-year-old girl received a reduced-intensity regimen consisting of fludarabine at 150 mg/m 2 , melphalan at 140 mg/m 2 and antithymocyte globulin [rabbit-ATG] and subsequently underwent an HSCT. In December 2004, 9 months after initial transplant, she underwent another HSCT with a preparative regimen of alemtuzumab 48mg total between days -21 and day -19 before transplant followed by fludarabine at 30 mg/m 2 for 5 days between days -8 and -4, thiotepa at 10 mg/kg on day -3 and melphalan at 140 mg/m 2 on day -2. On day +12 after the transplant, she developed a skin rash and fever, which was attributed to HHV-6 reactivation. She received foscarnet for 14 days and later continued treatment with voriconazole and valganciclovir as a post- transplant prophylaxis regimen. A 7-year-old boy received a preparative regimen with alemtuzumab 48mg total between days -21 and day -19 before transplant followed by fludarabine at 30 mg/m 2 for 5 days between days -8 and -4, thiotepa at 10 mg/kg on day -3 and melphalan at 140 mg/m 2 on day -2 and underwent an HSCT in November 2006. On day +11 after the transplant, increased HHV-6 viral copies were noted. He received foscarnet for 7 days and was later switched to valganciclovir. Author comment: "The major complication of alemtuzumab and fludarabine combination for effective recipient immunosuppression was the viral reactivation, especially HHV-6 virus." Soni S, et al. Successful unrelated umbilical cord blood transplantation for class 3 beta-thalassemia major using a reduced-toxicity regimen. Pediatric Transplantation 18: E41-E43, No. 2, Mar 2014. Available from: URL: http:// onlinelibrary.wiley.com/doi/10.1111/petr.12201/abstract - USA 803102908 1 Reactions 10 May 2014 No. 1500 0114-9954/14/1500-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1500, p8 - 10 May 2014
Antineoplastics
Human herpes virus 6 reactivation: 2 case reportsA boy and a girl, with class 3 β-thalassaemia major,
developed human herpes virus 6 (HHV-6) reactivation afteradministration of alemtuzumab, fludarabine, melphalan andthiotepa before haematopoietic stem cell transplantation(HSCT) as immunosuppressive and myeloablative therapy[routes and outcomes not stated]. Both the patients wereHHV-6 IgG positive prior to transplant.
A 5-year-old girl received a reduced-intensity regimenconsisting of fludarabine at 150 mg/m2, melphalan at140 mg/m2 and antithymocyte globulin [rabbit-ATG] andsubsequently underwent an HSCT. In December 2004,9 months after initial transplant, she underwent another HSCTwith a preparative regimen of alemtuzumab 48mg totalbetween days -21 and day -19 before transplant followed byfludarabine at 30 mg/m2 for 5 days between days -8 and -4,thiotepa at 10 mg/kg on day -3 and melphalan at 140 mg/m2 onday -2. On day +12 after the transplant, she developed a skinrash and fever, which was attributed to HHV-6 reactivation.She received foscarnet for 14 days and later continuedtreatment with voriconazole and valganciclovir as a post-transplant prophylaxis regimen.
A 7-year-old boy received a preparative regimen withalemtuzumab 48mg total between days -21 and day -19 beforetransplant followed by fludarabine at 30 mg/m2 for 5 daysbetween days -8 and -4, thiotepa at 10 mg/kg on day -3 andmelphalan at 140 mg/m2 on day -2 and underwent an HSCT inNovember 2006. On day +11 after the transplant, increasedHHV-6 viral copies were noted. He received foscarnet for7 days and was later switched to valganciclovir.
Author comment: "The major complication ofalemtuzumab and fludarabine combination for effectiverecipient immunosuppression was the viral reactivation,especially HHV-6 virus."Soni S, et al. Successful unrelated umbilical cord blood transplantation for class 3beta-thalassemia major using a reduced-toxicity regimen. Pediatric Transplantation18: E41-E43, No. 2, Mar 2014. Available from: URL: http://onlinelibrary.wiley.com/doi/10.1111/petr.12201/abstract - USA 803102908
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Reactions 10 May 2014 No. 15000114-9954/14/1500-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved
