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. 2022 Aug 3;9(8):ofac398. doi: 10.1093/ofid/ofac398

Table 1.

Comparison of Guideline Recommendations for Human Herpesvirus 6B DNA Monitoring and Therapy

Population ECIL, 2019 JSHCT, 2019 ASTCT, 2021
Allogeneic SCT Allogeneic SCTa CBTb
Accepted risk factors for HHV-6B encephalitis CBT, T-cell depleted allografts, unrelated donor or mismatched donor, aGVHD grades II–IV, glucocorticoid therapy CBT, male sex, unrelated donor or mismatched donor, corticosteroid therapy, pre-engraftment syndrome, engraftment syndrome, aGVHD Not discussed
Potential risk factors for HHV-6B encephalitis Haploidentical transplant, pre-engraftment syndrome Haploidentical transplant Not discussed
When to test for ciHHV-6 No indication for routine testing; consider if unclear 1–10 × 106 copies/mL in whole blood or persistent DNA in plasma or serum (strong) >105 copies/mL in whole blood or viremia unresponsive to therapy
Treatment

  • Foscarnet 90 mg/kg q12h OR ganciclovir 5 mg/kg q12h (AIIu)

  • Combination therapy may be considered (CIII)

  • Primary: foscarnet 60 mg/kg q8h or 90 mg/kg q12h (weak)

  • Secondary: ganciclovir 5 mg/kg q12h (weak)

  • Combination therapy in severe cases (weak)

 Not discussed
Duration of therapy At least 3 weeks with clearance of DNA from blood and, if possible, CSF (CIII) At least 3 weeks with clearance of DNA from blood and, if possible, CSF (weak) Not discussed
Prospective monitoring Not recommended (DIIu) Not recommended (weak) Can be considered, no evidence to support;
alternatively, as clinically indicated
Prophylactic therapy Not recommended (DIIu) Not recommended (weak) Not recommended
Preemptive therapy Not recommended (DIIu) No recommendation
No benefit to predict or prevent HHV-6B encephalitis		 Can consider for high-level viremia
Note no established threshold or evidence to support rolec
Notes No recommendation for treatment of end-organ disease outside of encephalitis (insufficient data) Can consider biweekly monitoring during weeks 2–6 after CBT (expert opinion), but not for use for preemptive therapy Note some centers prospectively monitor to day 60, but no evidence to support

Abbreviations: aGVHD, acute graft-vs-host disease; AIIu, Strongly supports a recommendation for use, based on evidence from at least one uncontrolled trial or from cohort- or case-control analytic studies; ASTCT, American Society for Transplantation and Cellular Therapy; CIII, Marginally supports a recommendation for use, expert opinion; CBT, cord blood transplant; ciHHV-6, chromosomally integrated human herpesvirus 6; CSF, cerebrospinal fluid; DIIu, Supports a recommendation against use, based on evidence from at least one uncontrolled trial or from cohort- or case-control analytic studies; ECIL, European Conference on Infections in Leukaemia; HHV-6B, human herpesvirus 6B; JSHCT, Japan Society for Hematopoietic Cell Transplantation; q8h, every 8 hours; q12h, every 12 hours; SCT, stem cell transplant.

a

Specific to HHV-6B encephalitis.

b

Guideline for infection prophylaxis after CBT, not specific to HHV-6B.

c

Refers to ECIL guideline for preemptive therapy, which explicitly recommends against preemptive therapy.