title: Valganciclovir suppressed Epstein Barr virus reactivation during immunosuppression with alemtuzumab.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Valganciclovir suppressed EBV reactivation during alemtuzumab therapy. It might be a useful prophylaxis in immunocompromized patient populations at high risk of EBV reactivation.
authors: Department of Medicine, Queen Mary Hospital, Hong Kong.
authors: Harinder
authors: H
authors: Gill
authors: Department of Medicine, Queen Mary Hospital, Hong Kong.
authors: Yu-Yan
authors: YY
authors: Hwang
authors: Department of Medicine, Queen Mary Hospital, Hong Kong.
authors: Thomas S Y
authors: TS
authors: Chan
authors: Department of Medicine, Queen Mary Hospital, Hong Kong.
authors: Annie W K
authors: AW
authors: Pang
authors: Department of Medicine, Queen Mary Hospital, Hong Kong.
authors: Anskar Y H
authors: AY
authors: Leung
authors: Department of Medicine, Queen Mary Hospital, Hong Kong.
authors: Eric
authors: E
authors: Tse
authors: Department of Medicine, Queen Mary Hospital, Hong Kong. Electronic address: ylkwong@hkucc.hku.hk.
authors: Yok-Lam
authors: YL
authors: Kwong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods; D004279:DNA, Viral / Q000097:blood; D020031:Epstein-Barr Virus Infections / Q000188:drug therapy / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004854:Herpesvirus 4, Human / Q000187:drug effects* / Q000302:isolation & purification / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D000077562:Valganciclovir; D019562:Viral Load; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: Alemtuzumab; Cytomegalovirus; Epstein Barr virus; Prophylaxis; Valganciclovir