title: High incidence of cytomegalovirus, human herpesvirus-6, and Epstein-Barr virus reactivation in patients receiving cytotoxic chemotherapy for adult T cell leukemia.
abstract: The etiology of cytomegalovirus (CMV), human herpesvirus-6 (HHV-6), and Epstein-Barr virus (EBV) reactivation and the potential for complications following cytotoxic chemotherapy in the absence of allogeneic transplantation are not clearly understood. Patients with adult T cell leukemia (ATL) are susceptible to opportunistic infections. In this study, the incidence, kinetics and clinical significance of reactivation of CMV, HHV-6, and EBV in ATL patients were investigated. Viral DNA in a total of 468 plasma samples from 34 patients was quantified using real-time PCR. The probability of CMV, HHV-6, and EBV reactivation by 100 days after the start of chemotherapy was 50.6%, 52.3%, and 21.6%, respectively. Although most CMV reactivations were self-limited, plasma CMV DNA tended to persist or increase if the CMV DNA levels in plasma reached ≥ 10(4) copies/ml. CMV reactivation was negatively associated with survival, but the P-value for this association was near the borderline of statistical significance (P=0.052). One patient developed fatal interstitial pneumonia concomitant with peak CMV DNA accumulation (1.6 × 10(6)  copies/ml plasma). Most HHV-6 and EBV reactivations were self-limited, and no disease resulting from HHV-6 or EBV was confirmed. HHV-6 and EBV reactivation were not associated with reduced survival (P=0.35 and 0.11, respectively). These findings demonstrated that subclinical reactivation of CMV, HHV-6, and EBV were common in ATL patients receiving chemotherapy. There were differences in the viral reactivation patterns among the three viruses. A CMV load ≥ 10(4) copies/ml plasma was indicative of subsequent exacerbation of CMV reactivation and developing serious clinical course.
authors.affiliation: Blood Transfusion Center, Oita University Hospital, Oita, Japan. mogata@med.oita-u.ac.jp
authors.forename: Masao
authors.initials: M
authors.lastname: Ogata
authors.forename: Takako
authors.initials: T
authors.lastname: Satou
authors.forename: Rie
authors.initials: R
authors.lastname: Kawano
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Junji
authors.initials: J
authors.lastname: Ikewaki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kohno
authors.forename: Takeaki
authors.initials: T
authors.lastname: Ando
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Eiichi
authors.initials: E
authors.lastname: Ohtsuka
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Saburi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kikuchi
authors.forename: Tetsunori
authors.initials: T
authors.lastname: Saikawa
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Kadota
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003586:Cytomegalovirus Infections / Q000139:chemically induced* / Q000821:virology; D004279:DNA, Viral / Q000097:blood; D004358:Drug Therapy / Q000379:methods; D064420:Drug-Related Side Effects and Adverse Reactions; D020031:Epstein-Barr Virus Infections / Q000139:chemically induced* / Q000821:virology; D005260:Female; D006801:Humans; D015994:Incidence; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D019349:Roseolovirus Infections / Q000139:chemically induced* / Q000821:virology; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D000970:Antineoplastic Agents; D004279:DNA, Viral