Quantificação simultânea dos oito herpesvírus humanos em transplante alogênico de células progenitoras hematopoiéticas

• Autor(a) principal: Oliveira, Paulo Guilherme Alvarenga Gomes de [UNIFESP]
• Data de Publicação: 2016
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4404218; https://repositorio.unifesp.br/handle/11600/46949
• topic: hematopoietic progenitor cell transplantation; human herpesviruses; viral infection; graft versus host disease; transplante de células progenitoras hematopoéticas; herpervírus humanos; infecção viral; doença do enxerto contra hospedeiro

Background: In the last few decades, hematopoietic stem cell transplantation (HSCT) has been successfully used for the treatment of malignant and nonmalignant disorders. There has been a rapid increase in the number and complexity of procedures worldwide due to a wider range of indications, improvements in conditioning regimens, infectious disease prophylaxis, and treatments for complications. However, the increasing complexity of HSCT has also led to a greater risk of opportunistic infections. Human herpesviruses are examples of opportunistic infections thet may cause severe complications after allogeneic HSCT. The impact of these viruses on the transplant outcomes remains unknown. This was a noninterventional study, aiming to analyze the incidence and the clinical impact of the eight herpesviruses (HSV1/HSV2/VZV/EBV/CMV/HHV6/HHV7/HHV8) infections in allogeneic HSCT recipients. Methods: A total of 98 patients were included in the study between August 2010 and December 2012. We prospectively analyzed the incidence of infection of the eight human herpesviruses simultaneously in 1,045 peripheral blood samples from 98 allogeneic HSCT recipients. Samples were collected weekly starting at the time of transplant until day +100. All herpesvíruses were screened and quantified in plasma by quantitative real-time PCR. Median follow up time was 45 months. Results: The incidences of infection for each herpesvírus were as follows: CMV=44%, HHV6=18%, HHV8=6%, EBV=3%, HSV1=3%, VZV=3%, HHV7=2%, and HSV2=1%. CMV infection was significantly more frequent among adults and was associated with a higher risk of developing acute graft-versus-host disease (GVHD). HHV6 infection was significantly more frequent after umbilical cord blood transplant and was associated with an increased risk of platelet engraftment failure. All patients presenting with HHV8 infection also developed chronic GVHD. There was no significant impact of these infections on the other transplant outcomes. Conclusions: Herpesviruses infections were uncommon after HSCT, except for CMV and HHV6. Although relatively frequent, these viruses had no clinically relevant impact on the outcomes, except for the association observed between CMV and acute GVHD and between HHV6 and delayed platelet engraftment. It was not possible to identify clinical syndromes attributable to viruses studied due to the heterogeneity and specificity of signs and symptoms.