Valganciclovir suppressed Epstein Barr virus reactivation during immunosuppression with alemtuzumab
Valganciclovir suppressed Epstein Barr virus reactivation during immunosuppression with alemtuzumab
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DOI：
10.1016/j.jcv.2014.01.005
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发表时间：
2014-04-01
影响因子：
8.8
通讯作者：
Kwong, Yok-Lam
中科院分区：
文献类型：
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作者：
Gill, Harinder;Hwang, Yu-Yan;Kwong, Yok-Lam
背景：免疫抑制可使潜伏的疱疹病毒复活。Alemtuzumab是一种靶向CD52的抗体，在所有B细胞和T细胞上表达。Alemtuzumab治疗导致严重的T细胞抑制，并发生巨细胞病毒（CMV）和EB病毒（EBV）的再活化。Valganciclovir是用来作为一种抗-CMV预防在alemtuzumab therapy.Objective：以确定是否EBV再活化是减少valganciclovir prophylaxis. Study design：血浆EBV DNA连续定量定量聚合酶链反应与世界卫生组织EBV标准的患者接受alemtuzumab治疗与valganciclovir作为抗-CMV prophylaxis. Results：29例患者进行了研究。共对258份样本进行定量，每例患者的中位数为7（3 - 25）份样本。24名患者从未有任何可量化的EBV DNA。5例患者（17%）发生EBV再激活。两名患者的EBV再活化水平非常低，约为103 IU/mL，比移植后淋巴组织增生性疾病中通常发现的水平低3 - 4 log。3例患者在较高水平（104 IU/mL）下发生EBV再活化，仅在两个疗程的Alemtuzumab给药后发生。4例EBV再激活自发消退。一名患者发生EBV阳性霍奇金淋巴瘤，但他也收到了以前另一种有效的T细胞抑制药物fludarabine.Conclusion：缬更昔洛韦抑制EBV再激活阿仑单抗治疗期间。这可能是一个有用的预防免疫功能低下的患者人群在高风险的EBV再激活。(C)2014爱思唯尔有限公司版权所有。
Background: Reactivation of latent herpes viruses occurs with immunosuppression. Alemtuzumab is an antibody targeting CD52, which is expressed on all B- and T-cells. Treatment with alemtuzumab leads to profound T-cell suppression, and reactivation of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) occurs. Valganciclovir is used as an anti-CMV prophylaxis during alemtuzumab therapy.Objective: To determine if EBV reactivation is decreased with valganciclovir prophylaxis.Study design: Plasma EBV DNA was serially quantified by quantitative polymerase chain reaction with a World Health Organization EBV standard in patients receiving alemtuzumab therapy with valganciclovir as anti-CMV prophylaxis.Results: Twenty-nine patients were studied. A total of 258 samples were quantified, at a median of 7 (3-25) specimens per patient. Twenty-four patients never had any quantifiable EBV DNA. Five patients (17%) developed EBV reactivation. Two patients had EBV reactivation at very low levels of about 103 IU/mL, 3-4 logs lower than those typically found in post-transplant lymphoproliferative diseases. Three patients had EBV reactivation at higher levels of 104 IU/mL, which only occurred after two courses of alemtuzumab were administered. EBV reactivation subsided spontaneously in four cases. One patient developed EBV-positive Hodgkin lymphoma, but he had also received previously another potent T-cell suppressing drug fludarabine.Conclusion: Valganciclovir suppressed EBV reactivation during alemtuzumab therapy. It might be a useful prophylaxis in immunocompromized patient populations at high risk of EBV reactivation. (C) 2014 Elsevier B.V. All rights reserved.