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<p>In this registry-based study, we evaluated the efficacy of different antiviral therapies for adult patients who developed human herpesvirus-6B (HHV-6B) encephalitis after their first cord blood transplantation (CBT). Among 3,862 CBT recipients registered in Japan between January 2019 and December 2023, HHV-6B encephalitis occurred in 289 patients within 100 days post-transplant (7.5%). Antiviral treatments included foscarnet (FCN) monotherapy (<i>n</i> = 190), ganciclovir (GCV) monotherapy (<i>n</i> = 12), and FCN/GCV combination therapy (<i>n</i> = 74). The FCN/GCV group was associated with a potential improvement in 1-year survival compared with the FCN and GCV groups (63.2% vs. 52.5% vs. 41.7%, <i>p</i> = 0.38). Moreover, FCN/GCV therapy was identified as an independent predictor of improved survival compared with FCN monotherapy (HR, 0.60; 95% CI, 0.38–0.95; <i>p</i> = 0.031). Furthermore, the combination FCN/GCV therapy showed better survival than FCN monotherapy in the patients after neutrophil engraftment (1-year survival 68.1% vs. 51.6%), but worse survival in patients before engraftment (1-year survival 34.1% vs. 54.6%). Together, these findings provide real-world evidence linking antiviral regimen selection to post-transplant outcomes in HHV-6B encephalitis and suggest that FCN/GCV combination therapy may offer a survival advantage over FCN monotherapy in selected CBT patients, with treatment strategies potentially tailored according to hematologic recovery.</p><p></p>

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Impact of antiviral therapies on survival in patients with HHV-6B encephalitis after cord blood transplantation: a real-world study

  • 期刊论文

  • 发表日期：

    2026年4月14日

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  • Toshiki Terao,
  • Wataru Kitamura,
  • Takahiro Fujino,
  • Takami Haruyama,
  • Yuri Okazoe,
  • Naoyuki Uchida,
  • Masatsugu Tanaka,
  • Atsushi Wake,
  • Masahito Tokunaga,
  • Keisuke Kataoka,
  • Masashi Sawa,
  • Makoto Onizuka,
  • Masako Toyosaki,
  • Koichi Onodera,
  • Tetsuya Nishida,
  • Yuta Katayama,
  • Takeshi Maeda,
  • Yuta Hasegawa,
  • Shunya Arai,
  • Makoto Yoshimitsu,
  • Takahiro Fukuda,
  • Marie Ohbiki,
  • Yoshiko Atsuta,
  • Kimikazu Yakushijin,
  • Masao Ogata,
  • Hideki Nakasone

摘要

In this registry-based study, we evaluated the efficacy of different antiviral therapies for adult patients who developed human herpesvirus-6B (HHV-6B) encephalitis after their first cord blood transplantation (CBT). Among 3,862 CBT recipients registered in Japan between January 2019 and December 2023, HHV-6B encephalitis occurred in 289 patients within 100 days post-transplant (7.5%). Antiviral treatments included foscarnet (FCN) monotherapy (n = 190), ganciclovir (GCV) monotherapy (n = 12), and FCN/GCV combination therapy (n = 74). The FCN/GCV group was associated with a potential improvement in 1-year survival compared with the FCN and GCV groups (63.2% vs. 52.5% vs. 41.7%, p = 0.38). Moreover, FCN/GCV therapy was identified as an independent predictor of improved survival compared with FCN monotherapy (HR, 0.60; 95% CI, 0.38–0.95; p = 0.031). Furthermore, the combination FCN/GCV therapy showed better survival than FCN monotherapy in the patients after neutrophil engraftment (1-year survival 68.1% vs. 51.6%), but worse survival in patients before engraftment (1-year survival 34.1% vs. 54.6%). Together, these findings provide real-world evidence linking antiviral regimen selection to post-transplant outcomes in HHV-6B encephalitis and suggest that FCN/GCV combination therapy may offer a survival advantage over FCN monotherapy in selected CBT patients, with treatment strategies potentially tailored according to hematologic recovery.