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Blood, 15 April 2007, Vol. 109, No. 8, pp. 3219-3224. Prepublished online as a Blood First Edition Paper on December 5, 2006; DOI 10.1182/blood-2006-09-045625. This Article Full Text (PDF) All Versions of this Article: blood-2006-09-045625v1 109/8/3219    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Scheinberg, P. Articles by Barrett, A. J. Search for Related Content PubMed PubMed Citation Articles by Scheinberg, P. Articles by Barrett, A. J. Related Collections Related Articles in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted September 6, 2006 Accepted November 25, 2006 Distinct EBV and CMV reactivation patterns following antibody-based immunosuppressive regimens in patients with severe aplastic anemia Phillip Scheinberg*, Steven H. Fischer, Li Li, Olga Nunez, Colin O. Wu, Elaine M. Sloand, Jeffrey I. Cohen, Neal S. Young, and A. John Barrett Hematology Branch, National Heart, Lung and Blood Institute, NIH, Bethesda, MD Department of Laboratory Medicine, Warren Grant Magnuson Clinical Center, NIH, Bethesda, MD Office of Biostatistics Research, National Heart, Lung and Blood Institute, NIH, Bethesda, MD Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD * Corresponding author; email: scheinbp{at}mail.nih.gov. The natural history of EBV and CMV reactivation and the potential for serious complications following antibody-based immunosuppressive treatment for bone marrow failure syndromes in the absence of transplantation is not known. We monitored blood for EBV and CMV reactivation by polymerase chain reaction (PCR) weekly in 78 consecutive patients (total of 99 immunosuppressive courses) with aplastic anemia. Four regimens were studied: (1) HC: horse ATG/cyclosporine; (2) HCS: horse ATG/CsA/sirolimus; (3) RC: rabbit ATG/CsA; and (4) CP: alemtuzumab. There were no cases of EBV or CMV disease but EBV reactivation occurred in 82/94 (87%) and CMV reactivation in 19/57 (33%) of seropositive patients after starting immunosuppression. The median peak EBV copies were higher in the RC group when compared to HC, HCS and alemtuzumab (P < 0.001). The median duration of PCR positivity for EBV was higher in the RC group compared to HC, HCS and alemtuzumab (P=0.001). Subclinical reactivation of both EBV and CMV is common and nearly always self-limited in patients with bone marrow failure receiving immunosuppression; different regimens are associated with different intensity of immunosuppression as measured by viral load and lymphocyte count; and viral reactivation patterns differ according to immunosuppressive regimens. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Articles in Blood Online: Monitoring of EBV reactivation is justified in patients with aplastic anemia treated with rabbit ATG as a second course of immunosuppression Marielle J. Wondergem, Servi J.C. Stevens, Jeroen J.W.M. Janssen, Joost J. Oudejans, Gert J. Ossenkoppele, Jaap M. Middeldorp, and Sonja Zweegman Blood 2008 111: 1739. [Full Text] [PDF] Response: EBV reactivation in the immunosuppressed: to treat or not to treat? Phillip Scheinberg, Neal S. Young, and John Barrett Blood 2008 111: 1739-1740. [Full Text] [PDF] This article has been cited by other articles: D. O'Mahony, J. C. Morris, M. Stetler-Stevenson, H. Matthews, M. R. Brown, T. Fleisher, S. Pittaluga, M. Raffeld, P. S. Albert, D. Reitsma, et al. EBV-Related Lymphoproliferative Disease Complicating Therapy with the Anti-CD2 Monoclonal Antibody, Siplizumab, in Patients with T-Cell Malignancies Clin. Cancer Res., April 1, 2009; 15(7): 2514 - 2522. [Abstract] [Full Text] [PDF] D. M. Lyu and M. R. Zamora Medical Complications of Lung Transplantation Proceedings of the ATS, January 15, 2009; 6(1): 101 - 107. [Abstract] [Full Text] [PDF] M. J. Wondergem, S. J.C. Stevens, J. J.W.M. Janssen, J. J. Oudejans, G. J. Ossenkoppele, J. M. Middeldorp, and S. Zweegman Monitoring of EBV reactivation is justified in patients with aplastic anemia treated with rabbit ATG as a second course of immunosuppression Blood, February 1, 2008; 111(3): 1739 - 1739. [Full Text] [PDF] T. Tuuminen, E. Kekalainen, S. Makela, I. Ala-Houhala, F. A. Ennis, K. Hedman, J. Mustonen, A. Vaheri, and T. P. Arstila Human CD8+ T Cell Memory Generation in Puumala Hantavirus Infection Occurs after the Acute Phase and Is Associated with Boosting of EBV-Specific CD8+ Memory T Cells J. Immunol., August 1, 2007; 179(3): 1988 - 1995. [Abstract] [Full Text] [PDF]

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