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Valganciclovir suppressed Epstein Barr virus reactivation during immunosuppression with alemtuzumab.

Discussion in 'Other Health News and Research' started by Ecoclimber, Mar 21, 2014.

  1. Ecoclimber

    Ecoclimber Senior Member

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    Mercer Island Wa
    J Clin Virol. 2014 Apr;59(4):255-8. doi: 10.1016/j.jcv.2014.01.005. Epub 2014 Jan 18.
    Valganciclovir suppressed Epstein Barr virus reactivation during immunosuppression with alemtuzumab.
    Gill H1, Hwang YY1, Chan TS1, Pang AW1, Leung AY1, Tse E1, Kwong YL2.
    Author information

    Abstract
    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 10(3)IU/mL, 3-4 logs lower than those typically found in post-transplant lymphoproliferative diseases. Three patients had EBV reactivation at higher levels of 10(4)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.

    Copyright © 2014 Elsevier B.V. All rights reserved.

    KEYWORDS:
    Alemtuzumab, Cytomegalovirus, Epstein Barr virus, Prophylaxis, Valganciclovir

    PMID:
    24507802
    [PubMed - in process]
    maryb and Valentijn like this.

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