Of the two human herpesvirus 6 (HHV-6) species, human herpesvirus 6B (HHV-6B) encephalitis is an important cause of morbidity and mortality after allogeneic hematopoietic stem cell transplant. Guidelines for the management of HHV-6 infections in patients with hematologic malignancies or post-transplant were prepared a decade ago but there have been no other guidelines since then despite significant advances in the understanding of HHV-6 encephalitis, its therapy, and other aspects of HHV-6 disease in this patient population. Revised guidelines prepared at the 2017 European Conference on Infections in Leukaemia covering diagnosis, preventative strategies and management of HHV-6 disease are now presented.

Department of Haematology Henri Mondor Hospital Assistance Publique Hopitaux de Paris Université Paris Est Créteil Créteil France

Department of Haematology Hospital de la Princesa Madrid Spain

Department of Medical Microbiology and Department of Paediatric Haematology and Oncology 2 Medical Faculty of Charles University and Motol University Hospital Prague Czech Republic

Division of Infection and Immunity University College London London UK

Fred Hutchinson Cancer Research Center Seattle WA USA

Medizinische Klinik und Poliklinik 2 Julius Maximilians Universität Würzburg Germany

Microbiology Service Hospital Clínico Universitario Instituto de Investigación INCLIVA and Department of Microbiology School of Medicine University of Valencia Valencia Spain

SIMT ASST di Bergamo Ovest Treviglio Italy

Zobrazit více v PubMed

Ablashi D, Agut H, Alvarez-Lafuente R, et al. Classification of HHV-6A and HHV-6B as distinct viruses. Arch Virol. 2014;159(5):863–870. PubMed PMC

De Bolle L, Naesens L, De Clercq E. Update on human herpesvirus 6 biology, clinical features, and therapy. Clin Microbiol Rev. 2005;18(1):217–245. PubMed PMC

Daibata M, Taguchi T, Nemoto Y, Taguchi H, Miyoshi I. Inheritance of chromosomally integrated human herpesvirus 6 DNA. Blood. 1999;94(5):1545–1549. PubMed

Tanaka-Taya K, Sashihara J, Kurahashi H, et al. Human herpesvirus 6 (HHV-6) is transmitted from parent to child in an integrated form and characterization of cases with chromosomally integrated HHV-6 DNA. J Med Virol. 2004;73(3):465–473. PubMed

Pellett PE, Ablashi DV, Ambros PF, et al. Chromosomally integrated human herpesvirus 6: questions and answers. Rev Med Virol. 2012;22(3):144–155. PubMed PMC

Nacheva EP, Ward KN, Brazma D, et al. Human herpesvirus 6 integrates within telomeric regions as evidenced by five different chromosomal sites. J Med Virol. 2008;80(11):1952–1958. PubMed

Ward KN, Leong HN, Nacheva EP, et al. Human herpesvirus 6 chromosomal integration in immunocompetent patients results in high levels of viral DNA in blood, sera, and hair follicles. J Clin Microbiol. 2006;44(4):1571–1574. PubMed PMC

Ward KN, Leong HN, Thiruchelvam AD, Atkinson CE, Clark DA. Human herpesvirus 6 DNA levels in cerebrospinal fluid due to primary infection differ from those due to chromosomal viral integration and have implications for diagnosis of encephalitis. J Clin Microbiol. 2007;45(4):1298–1304. PubMed PMC

Ward KN. Child and adult forms of human herpesvirus 6 encephalitis: looking back, looking forward. Curr Opin Neurol. 2014;27(3):349–355. PubMed

Endo A, Watanabe K, Ohye T, et al. Molecular and virological evidence of viral activation from chromosomally integrated human herpesvirus 6A in a patient with X-linked severe combined immunodeficiency. Clin Infect Dis. 2014;59(4):545–548. PubMed

Politikos I, McMasters M, Bryke C, Avigan D, Boussiotis VA. Possible reactivation of chromosomally integrated human herpesvirus 6 after treatment with histone deacetylase inhibitor. Blood Adv. 2018;2(12):1367–1370. PubMed PMC

Bonnafous P, Marlet J, Bouvet D, et al. Fatal outcome after reactivation of inherited chromosomally integrated HHV-6A (iciHHV-6A) transmitted through liver transplantation. Am J Transplant. 2018;18(6):1548–1551. PubMed

Clark DA, Nacheva EP, Leong HN, et al. Transmission of integrated human herpesvirus 6 through stem cell transplantation: implications for laboratory diagnosis. J Infect Dis. 2006;193(7):912–916. PubMed

Hubacek P, Hyncicova K, Muzikova K, Cinek O, Zajac M, Sedlacek P. Disappearance of pre-existing high HHV-6 DNA load in blood after allogeneic SCT. Bone Marrow Transplant. 2007;40(8):805–806. PubMed

Yagasaki H, Shichino H, Shimizu N, et al. Nine-year follow-up in a child with chromosomal integration of human herpesvirus 6 transmitted from an unrelated donor through the Japan Marrow Donor Program. Transpl Infect Dis. 2015;17(1):160–161. PubMed

Yamada Y, Osumi T, Imadome KI, et al. Transmission of chromosomally integrated human herpesvirus 6 via cord blood transplantation. Transpl Infect Dis. 2017;19(1):e12636. PubMed

Hill JA, Magaret AS, Hall-Sedlak R, et al. Outcomes of hematopoietic cell transplantation using donors or recipients with inherited chromosomally integrated HHV-6. Blood. 2017;130(8):1062–1069. PubMed PMC

Hubacek P, Muzikova K, Hrdlickova A, et al. Prevalence of HHV-6 integrated chromosomally among children treated for acute lymphoblastic or myeloid leukemia in the Czech Republic. J Med Virol. 2009;81(2): 258–263. PubMed

Hubacek P, Hrdlickova A, Spacek M, et al. Prevalence of chromosomally integrated HHV-6 in patients with malignant disease and healthy donors in the Czech Republic. Folia Microbiol (Praha). 2013;58(1):87–90. PubMed

Gravel A, Sinnett D, Flamand L. Frequency of chromosomally-integrated human herpesvirus 6 in children with acute lymphoblastic leukemia. PLoS One. 2013;8(12): e84322. PubMed PMC

Bell AJ, Gallagher A, Mottram T, et al. Germ-line transmitted, chromosomally integrated HHV-6 and classical Hodgkin lymphoma. PLoS One. 2014;9(11):e112642. PubMed PMC

Flamand L, Gravel A, Boutolleau D, et al. Multicenter comparison of PCR assays for detection of human herpesvirus 6 DNA in serum. J Clin Microbiol. 2008;46(8):2700–2706. PubMed PMC

Cassina G, Russo D, De BD, Broccolo F, Lusso P, Malnati MS. Calibrated real-time polymerase chain reaction for specific quantitation of HHV-6A and HHV-6B in clinical samples. J Virol Methods. 2013;189(1):172–179. PubMed

de Pagter PJ, Schuurman R, de Vos NM, Mackay W, van Loon AM. Multicenter external quality assessment of molecular methods for detection of human herpesvirus 6. J Clin Microbiol. 2010;48(7):2536–2540. PubMed PMC

Purev E, Winkler T, Danner RL, et al. Engraftment of donor cells with germline integration of HHV6 mimics HHV6 reactivation following cord blood/haplo transplantation. Blood. 2014;124(7):1198–1199. PubMed PMC

Hubacek P, Maalouf J, Zajickova M, et al. Failure of multiple antivirals to affect high HHV-6 DNAaemia resulting from viral chromosomal integration in a case of severe aplastic anaemia. Haematologica. 2007;92(10):e98–e100. PubMed

Jeulin H, Guery M, Clement L, et al. Chromosomally integrated HHV-6: slow decrease of HHV-6 viral load after hematopoietic stem-cell transplantation. Transplantation. 2009;88(9):1142–1143. PubMed

Hubacek P, Virgili A, Ward KN, et al. HHV-6 DNA throughout the tissues of two stem cell transplant patients with chromosomally integrated HHV-6 and fatal CMV pneumonitis. Br J Haematol. 2009;145(3):394–398. PubMed

Sedlak RH, Cook L, Huang ML, et al. Identification of chromosomally integrated human herpesvirus 6 by droplet digital PCR. Clin Chem. 2014;60(5):765–772. PubMed PMC

Lau YL, Peiris M, Chan GC, Chan AC, Chiu D, Ha SY. Primary human herpes virus 6 infection transmitted from donor to recipient through bone marrow infusion. Bone Marrow Transplant. 1998;21(10):1063–1066. PubMed

Muramatsu H, Watanabe N, Matsumoto K, et al. Primary infection of human herpesvirus-6 in an infant who received cord blood SCT. Bone Marrow Transplant. 2009;43(1):83–84. PubMed

Drobyski WR, Knox KK, Majewski D, Carrigan DR. Brief report: fatal encephalitis due to variant B human herpesvirus-6 infection in a bone marrow-transplant recipient. N Engl J Med. 1994;330(19):1356–1360. PubMed

Zerr DM. Human herpesvirus 6 and central nervous system disease in hematopoietic cell transplantation. J Clin Virol. 2006;37 Suppl 1:S52–S56. PubMed

Zerr DM, Ogata M. HHV-6A and HHV-6B in Recipients of Hematopoietic Cell Transplantation. In: Flamand L, Lautenschlager I, Krueger G, Ablashi D, editors. HHV-6A, HHV-6B & HHV-7 Diagnosis and Clinical Management. 3rd ed. San Francisco: Elsevier; 2014.

Hill JA, Sedlak RH, Zerr DM, et al. Prevalence of chromosomally integrated human herpesvirus 6 in patients with human herpesvirus 6-central nervous system dysfunction. Biol Blood Marrow Transplant. 2015;21(2):371–373. PubMed PMC

Ogata M, Oshima K, Ikebe T, et al. Clinical characteristics and outcome of human herpesvirus-6 encephalitis after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2017;52(11):1563–1570. PubMed

Noguchi T, Yoshiura T, Hiwatashi A, et al. CT and MRI findings of human herpesvirus 6-associated encephalopathy: comparison with findings of herpes simplex virus encephalitis. AJR Am J Roentgenol. 2010; 194(3):754–760. PubMed

Provenzale JM, van LK, White LE. Clinical and imaging findings suggesting human herpesvirus 6 encephalitis. Pediatr Neurol. 2010;42(1):32–39. PubMed

Bhanushali MJ, Kranick SM, Freeman AF, et al. Human herpes 6 virus encephalitis complicating allogeneic hematopoietic stem cell transplantation. Neurology. 2013;80(16): 1494–1500. PubMed PMC

Scheurer ME, Pritchett JC, Amirian ES, Zemke NR, Lusso P, Ljungman P. HHV-6 encephalitis in umbilical cord blood transplantation: a systematic review and meta-analysis. Bone Marrow Transplant. 2013;48(4):574–580. PubMed

Zerr DM, Fann JR, Breiger D, et al. HHV-6 reactivation and its effect on delirium and cognitive functioning in hematopoietic cell transplantation recipients. Blood. 2011;117(19):5243–5249. PubMed PMC

Hill JA, Boeckh MJ, Sedlak RH, Jerome KR, Zerr DM. Human herpesvirus 6 can be detected in cerebrospinal fluid without associated symptoms after allogeneic hematopoietic cell transplantation. J Clin Virol. 2014;61(2):289–292. PubMed PMC

Hill JA, Boeckh M, Leisenring WM, et al. Human herpesvirus 6B reactivation and delirium are frequent and associated events after cord blood transplantation. Bone Marrow Transplant. 2015;50(10):1348–1351. PubMed PMC

Ueki T, Hoshi K, Hiroshima Y, et al. Analysis of five cases of human herpesvirus-6 myelitis among 121 cord blood transplantations. Int J Hematol. 2018;107(3):363–372. PubMed

Zerr DM, Boeckh M, Delaney C, et al. HHV-6 reactivation and associated sequelae after hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2012;18(11): 1700–1708. PubMed PMC

Dulery R, Salleron J, Dewilde A, et al. Early human herpesvirus type 6 reactivation after allogeneic stem cell transplantation: a large-scale clinical study. Biol Blood Marrow Transplant. 2012;18(7):1080–1089. PubMed

Olson AL, Dahi PB, Zheng J, et al. Frequent human herpesvirus-6 viremia but low incidence of encephalitis in double-unit cord blood recipients transplanted without antithymocyte globulin. Biol Blood Marrow Transplant. 2014;20(6):787–793. PubMed PMC

Ogata M, Satou T, Kadota J, et al. Human herpesvirus 6 (HHV-6) reactivation and HHV-6 encephalitis after allogeneic hematopoietic cell transplantation: a multicenter, prospective study. Clin Infect Dis. 2013;57(5):671–681. PubMed

Hill JA, Koo S, Guzman Suarez BB, et al. Cord-blood hematopoietic stem cell transplant confers an increased risk for human herpesvirus-6-associated acute limbic encephalitis: a cohort analysis. Biol Blood Marrow Transplant. 2012;18(11):1638–1648. PubMed PMC

Ogata M, Fukuda T, Teshima T. Human herpesvirus-6 encephalitis after allogeneic hematopoietic cell transplantation: what we do and do not know. Bone Marrow Transplant 2015; 50(8):1030–1036. PubMed

Perruccio K, Sisinni L, Perez-Martinez A, et al. High Incidence of Early Human Herpesvirus-6 Infection in Children Undergoing Haploidentical Manipulated Stem Cell Transplantation for Hematologic Malignancies. Biol Blood Marrow Transplant. 2018;24(12):2549–2557. PubMed

Howell KB, Tiedemann K, Haeusler G, et al. Symptomatic generalized epilepsy after HHV6 posttransplant acute limbic encephalitis in children. Epilepsia. 2012;53(7):e122–e126. PubMed

Raspall-Chaure M, Armangue T, Elorza I, Sanchez-Montanez A, Vicente-Rasoamalala M, Macaya A. Epileptic encephalopathy after HHV6 post-transplant acute limbic encephalitis in children: confirmation of a new epilepsy syndrome. Epilepsy Res. 2013;105(3):419–422. PubMed

Isomura H, Yoshida M, Namba H, et al. Suppressive effects of human herpesvirus-6 on thrombopoietin-inducible megakaryocytic colony formation in vitro. J Gen Virol. 2000;81(Pt 3):663–673. PubMed

Ljungman P, Wang FZ, Clark DA, et al. High levels of human herpesvirus 6 DNA in peripheral blood leucocytes are correlated to platelet engraftment and disease in allogeneic stem cell transplant patients. Br J Haematol. 2000;111(3):774–781. PubMed

Zerr DM, Corey L, Kim HW, Huang ML, Nguy L, Boeckh M. Clinical outcomes of human herpesvirus 6 reactivation after hematopoietic stem cell transplantation. Clin Infect Dis. 2005;40(7):932–940. PubMed

Lagadinou ED, Marangos M, Liga M, et al. Human herpesvirus 6-related pure red cell aplasia, secondary graft failure, and clinical severe immune suppression after allogeneic hematopoietic cell transplantation successfully treated with foscarnet. Transpl Infect Dis. 2010;12(5):437–440. PubMed

Le Bourgeois A, Labopin M, Guillaume T, et al. Human herpesvirus 6 reactivation before engraftment is strongly predictive of graft failure after double umbilical cord blood allogeneic stem cell transplantation in adults. Exp Hematol. 2014;42(11):945–954. PubMed

Carrigan DR, Drobyski WR, Russler SK, Tapper MA, Knox KK, Ash RC. Interstitial pneumonitis associated with human herpesvirus-6 infection after marrow transplantation. Lancet. 1991;338(8760):147–149. PubMed

Cone RW, Hackman RC, Huang ML, et al. Human herpesvirus 6 in lung tissue from patients with pneumonitis after bone marrow transplantation. N Engl J Med. 1993; 329(3):156–161. PubMed

Buchbinder S, Elmaagacli AH, Schaefer UW, Roggendorf M. Human herpesvirus 6 is an important pathogen in infectious lung disease after allogeneic bone marrow transplantation. Bone Marrow Transplant. 2000;26(6):639–644. PubMed

Nishimaki K, Okada S, Miyamura K, et al. The possible involvement of human herpesvirus type 6 in obliterative bronchiolitis after bone marrow transplantation. Bone Marrow Transplant. 2003;32(11):1103–1105. PubMed

Seo S, Renaud C, Kuypers JM, et al. Idiopathic pneumonia syndrome after hematopoietic cell transplantation: evidence of occult infectious etiologies. Blood. 2015;125(24):3789–3797. PubMed PMC

Hill JA, Myerson D, Sedlak RH, Jerome KR, Zerr DM. Hepatitis due to human herpesvirus 6B after hematopoietic cell transplantation and a review of the literature. Transpl Infect Dis. 2014;16(3):477–483. PubMed PMC

Kuribayashi K, Matsunaga T, Iyama S, et al. Human herpesvirus-6 hepatitis associated with cyclosporine-A encephalitis after bone marrow transplantation for chronic myeloid leukemia. Intern Med. 2006;45(7): 475–478. PubMed

Crocchiolo R, Giordano L, Rimondo A, et al. Human Herpesvirus 6 replication predicts Cytomegalovirus reactivation after allogeneic stem cell transplantation from haploidentical donor. J Clin Virol. 2016;84: 24–26. PubMed

Tormo N, Solano C, de la Camara R, et al. An assessment of the effect of human her-pesvirus-6 replication on active cytomegalovirus infection after allogeneic stem cell transplantation. Biol Blood Marrow Transplant. 2010;16(5):653–661. PubMed

Wang FZ, Larsson K, Linde A, Ljungman P. Human herpesvirus 6 infection and cytomegalovirus-specific lymphoproliferative responses in allogeneic stem cell transplant recipients. Bone Marrow Transplant. 2002;30(8):521–526. PubMed

Smith AP, Paolucci C, Di Lullo G, Burastero SE, Santoro F, Lusso P. Viral replication-independent blockade of dendritic cell maturation and interleukin-12 production by human herpesvirus 6. J Virol. 2005;79(5): 2807–2813. PubMed PMC

Lusso P. HHV-6 and the immune system: mechanisms of immunomodulation and viral escape. J Clin Virol. 2006; 37 Suppl 1:S4–10. PubMed

Admiraal R, de Koning CCH, Lindemans CA, et al. Viral reactivations and associated outcomes in the context of immune reconstitution after pediatric hematopoietic cell transplantation. J Allergy Clin Immunol. 2017;140(6):1643–1650. PubMed

Phan TL, Carlin K, Ljungman P, et al. Human Herpesvirus-6B Reactivation Is a Risk Factor for Grades II to IV Acute Graft-versus-Host Disease after Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis. Biol Blood Marrow Transplant. 2018;24(11):2324–2336. PubMed PMC

de Pagter PJ, Schuurman R, Visscher H, et al. Human herpes virus 6 plasma DNA positivity after hematopoietic stem cell transplantation in children: an important risk factor for clinical outcome. Biol Blood Marrow Transplant. 2008;14(7):831–839. PubMed

Hill JA, Mayer BT, Xie H, et al. Kinetics of Double-Stranded DNA Viremia After Allogeneic Hematopoietic Cell Transplantation. Clin Infect Dis. 2018;66(3):368–375. PubMed PMC

Prichard MN, Whitley RJ. The development of new therapies for human herpesvirus 6. Curr Opin Virol. 201;9:148–153. PubMed PMC

Manichanh C, Olivier-Aubron C, Lagarde JP, et al. Selection of the same mutation in the U69 protein kinase gene of human herpesvirus-6 after prolonged exposure to ganciclovir in vitro and in vivo. J Gen Virol. 2001;82(Pt 11):2767–2776. PubMed

Isegawa Y, Hara J, Amo K, et al. Human herpesvirus 6 ganciclovir-resistant strain with amino acid substitutions associated with the death of an allogeneic stem cell transplant recipient. J Clin Virol. 2009;44(1):15–19. PubMed

Baldwin K. Ganciclovir-resistant human herpesvirus-6 encephalitis in a liver transplant patient: a case report. J Neurovirol. 2011;17(2):193–195. PubMed

Piret J, Boivin G. Antiviral drug resistance in herpesviruses other than cytomegalovirus. Rev Med Virol. 2014;24(3):186–218. PubMed

Bounaadja L, Piret J, Goyette N, Boivin G. Analysis of HHV-6 mutations in solid organ transplant recipients at the onset of cytomegalovirus disease and following treatment with intravenous ganciclovir or oral valganciclovir. J Clin Virol. 2013;58(1): 279–282. PubMed

Williams-Aziz SL, Hartline CB, Harden EA, et al. Comparative activities of lipid esters of cidofovir and cyclic cidofovir against replication of herpesviruses in vitro. Antimicrob Agents Chemother. 2005;49(9):3724–3733. PubMed PMC

Marty FM, Winston DJ, Chemaly RF, et al. A Randomized, Double-Blind, Placebo-Controlled Phase 3 Trial of Oral Brincidofovir for Cytomegalovirus Prophylaxis in Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant. 2019;25(2):369–381. PubMed PMC

Wire MB, Morrison M, Anderson M, Arumugham T, Dunn J, Naderer O. Pharmokinetics (PK) and Safety of Intravenous (IV) Brincidofovir (BCV) in Healthy Adult Subjects. Open Forum Infect Dis. 2017;4(Suppl 1):S311.

Becerra A, Gibson L, Stern LJ, Calvo-Calle JM. Immune response to HHV-6 and implications for immunotherapy. Curr Opin Virol. 2014;9:154–161. PubMed PMC

Tzannou I, Papadopoulou A, Naik S, et al. Off-the-Shelf Virus-Specific T Cells to Treat BK Virus, Human Herpesvirus 6, Cytomegalovirus, Epstein-Barr Virus, and Adenovirus Infections After Allogeneic Hematopoietic Stem-Cell Transplantation. J Clin Oncol. 2017;35(31):3547–3557. PubMed PMC

Ishiyama K, Katagiri T, Ohata K, et al. Safety of pre-engraftment prophylactic foscarnet administration after allogeneic stem cell transplantation. Transpl Infect Dis. 2012;14(1):33–39. PubMed

Ogata M, Satou T, Inoue Y, et al. Foscarnet against human herpesvirus (HHV)-6 reactivation after allo-SCT: breakthrough HHV-6 encephalitis following antiviral prophylaxis. Bone Marrow Transplant. 2013;48(2):257–264. PubMed

Ogata M, Takano K, Moriuchi Y, et al. Effects of Prophylactic Foscarnet on Human Herpesvirus-6 Reactivation and Encephalitis in Cord Blood Transplant Recipients: A Prospective Multicenter Trial with an Historical Control Group. Biol Blood Marrow Transplant. 2018;24(6):1264–1273. PubMed

Ogata M, Satou T, Kawano R, et al. Plasma HHV-6 viral load-guided preemptive thera py against HHV-6 encephalopathy after allogeneic stem cell transplantation: a prospective evaluation. Bone Marrow Transplant. 2008;41(3):279–285. PubMed

Ishiyama K, Katagiri T, Hoshino T, Yoshida T, Yamaguchi M, Nakao S. Preemptive therapy of human herpesvirus-6 encephalitis with foscarnet sodium for high-risk patients after hematopoietic SCT. Bone Marrow Transplant. 2011;46(6):863–869. PubMed

Zerr DM, Gupta D, Huang ML, Carter R, Corey L. Effect of antivirals on human herpesvirus 6 replication in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34(3):309–317. PubMed

Ljungman P, Dahl H, Xu YH, Larsson K, Brytting M, Linde A. Effectiveness of ganciclovir against human herpesvirus-6 excreted in saliva in stem cell transplant recipients. Bone Marrow Transplant 2007; 39(8):497–499. PubMed

Vu T, Carrum G, Hutton G, Heslop HE, Brenner MK, Kamble R. Human herpesvirus-6 encephalitis following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2007;39(11):705–709. PubMed

Ljungman P, de la Camara R, Cordonnier C, et al. Management of CMV, HHV-6, HHV-7 and Kaposi-sarcoma herpesvirus (HHV-8) infections in patients with hematological malignancies and after SCT. Bone Marrow Transplant. 2008;42(4):227–240. PubMed

Schmidt-Hieber M, Schwender J, Heinz WJ, et al. Viral encephalitis after allogeneic stem cell transplantation: a rare complication with distinct characteristics of different causative agents. Haematologica. 2011;96(1):142–149. PubMed PMC

Denes E, Magy L, Pradeau K, Alain S, Weinbreck P, Ranger-Rogez S. Successful treatment of human herpesvirus 6 encephalomyelitis in immunocompetent patient. Emerg Infect Dis. 2004;10(4):729–731. PubMed PMC

Pohlmann C, Schetelig J, Reuner U, et al. Cidofovir and foscarnet for treatment of human herpesvirus 6 encephalitis in a neutropenic stem cell transplant recipient. Clin Infect Dis. 2007;44(12):e118–e120. PubMed

Hill JA, Zerr DM. Human herpesvirus 6A, 6B, 7 and 8 infections After Hematopoietic Stem Cell Transplantation. In: Ljungman P, Snydman D, Boeckh M, editors. Switzerland: Springer International; 2016. pp.547–562.

Hill JA, Zerr DM. Roseoloviruses in transplant recipients: clinical consequences and prospects for treatment and prevention trials. Curr Opin Virol. 2014;9:53–60. PubMed PMC