Reactivation and dynamics of cytomegalovirus and Epstein-Barr virus after rabbit antithymocyte globulin and cyclosporine for aplastic anemia

Sung Soo Park; Sung Yeon Cho; Eunhee Han; Gi June Min; Silvia Park; Jae Ho Yoon; Sung Eun Lee; Byung Sik Cho; Ki Seong Eom; Yoo Jin Kim; Seok Lee; Hee Je Kim; Chang Ki Min; Seok Goo Cho; Jong Wook Lee

doi:10.1111/ejh.13308

Reactivation and dynamics of cytomegalovirus and Epstein-Barr virus after rabbit antithymocyte globulin and cyclosporine for aplastic anemia

Sung Soo Park, Sung Yeon Cho, Eunhee Han, Gi June Min, Silvia Park, Jae Ho Yoon, Sung Eun Lee, Byung Sik Cho, Ki Seong Eom, Yoo Jin Kim, Seok Lee, Hee Je Kim, Chang Ki Min, Seok Goo Cho, Jong Wook Lee

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6 Scopus citations

Abstract

Objectives: This study aimed to identify the natural course of cytomegalovirus (CMV)/Epstein-Barr virus (EBV) after rabbit antithymocyte globulin and cyclosporine (rATG-CsA) for aplastic anemia (AA). Methods: In 113 prospectively observed AA patients treated with rATG-CsA, the CMV/EBV cohort was classified into two groups by baseline viremic status: no viremia (CMV-G1, n = 112; EBV-G1, n = 98) and the presence of viremia (CMV-G2, n = 1; EBV-G2, n = 13). Results: In CMV-G1, the mean CMV load increased up to 3 months but was completely resolved from 6 months. The mean EBV load of EBV-G1 showed a peak at 1 month and then gradually decreased over time but remained detectable throughout the observation period. EBV-G2 showed fluctuating EBV dynamics. With reactivation rates of 38.4% in CMV-G1 and 62.2% in EBV-G1, a longer time to rATG-CsA from diagnosis and a lower absolute lymphocyte count at 1 month from rATG-CsA were significantly associated with CMV and EBV reactivation, respectively. The mean peak CMV and EBV loads of patients with CMV-related (3.5%) and EBV-related (0.9%) diseases were evidently higher than those of the remaining patients without CMV and EBV diseases in the respective cohort. Conclusion: Considering frequent reactivation and distinct courses of CMV/EBV, virologic surveillance is recommended after rATG-CsA for AA.

Original language	English
Pages (from-to)	433-441
Number of pages	9
Journal	European Journal of Haematology
Volume	103
Issue number	4
DOIs	https://doi.org/10.1111/ejh.13308
State	Published - 1 Oct 2019

Bibliographical note

Publisher Copyright:
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Keywords

Epstein-Barr virus
aplastic anemia
cytomegalovirus
immunosuppressive therapy
thymoglobulin

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10.1111/ejh.13308

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Park, S. S., Cho, S. Y., Han, E., Min, G. J., Park, S., Yoon, J. H., Lee, S. E., Cho, B. S., Eom, K. S., Kim, Y. J., Lee, S., Kim, H. J., Min, C. K., Cho, S. G., & Lee, J. W. (2019). Reactivation and dynamics of cytomegalovirus and Epstein-Barr virus after rabbit antithymocyte globulin and cyclosporine for aplastic anemia. European Journal of Haematology, 103(4), 433-441. https://doi.org/10.1111/ejh.13308

@article{bdc94eb7e51443259277903011b1b24c,

title = "Reactivation and dynamics of cytomegalovirus and Epstein-Barr virus after rabbit antithymocyte globulin and cyclosporine for aplastic anemia",

abstract = "Objectives: This study aimed to identify the natural course of cytomegalovirus (CMV)/Epstein-Barr virus (EBV) after rabbit antithymocyte globulin and cyclosporine (rATG-CsA) for aplastic anemia (AA). Methods: In 113 prospectively observed AA patients treated with rATG-CsA, the CMV/EBV cohort was classified into two groups by baseline viremic status: no viremia (CMV-G1, n = 112; EBV-G1, n = 98) and the presence of viremia (CMV-G2, n = 1; EBV-G2, n = 13). Results: In CMV-G1, the mean CMV load increased up to 3 months but was completely resolved from 6 months. The mean EBV load of EBV-G1 showed a peak at 1 month and then gradually decreased over time but remained detectable throughout the observation period. EBV-G2 showed fluctuating EBV dynamics. With reactivation rates of 38.4% in CMV-G1 and 62.2% in EBV-G1, a longer time to rATG-CsA from diagnosis and a lower absolute lymphocyte count at 1 month from rATG-CsA were significantly associated with CMV and EBV reactivation, respectively. The mean peak CMV and EBV loads of patients with CMV-related (3.5%) and EBV-related (0.9%) diseases were evidently higher than those of the remaining patients without CMV and EBV diseases in the respective cohort. Conclusion: Considering frequent reactivation and distinct courses of CMV/EBV, virologic surveillance is recommended after rATG-CsA for AA.",

keywords = "Epstein-Barr virus, aplastic anemia, cytomegalovirus, immunosuppressive therapy, thymoglobulin",

author = "Park, {Sung Soo} and Cho, {Sung Yeon} and Eunhee Han and Min, {Gi June} and Silvia Park and Yoon, {Jae Ho} and Lee, {Sung Eun} and Cho, {Byung Sik} and Eom, {Ki Seong} and Kim, {Yoo Jin} and Seok Lee and Kim, {Hee Je} and Min, {Chang Ki} and Cho, {Seok Goo} and Lee, {Jong Wook}",

note = "Publisher Copyright: {\textcopyright} 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd",

year = "2019",

month = oct,

day = "1",

doi = "10.1111/ejh.13308",

language = "English",

volume = "103",

pages = "433--441",

journal = "European Journal of Haematology",

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Park, SS , Cho, SY , Han, E , Min, GJ , Park, S , Yoon, JH , Lee, SE , Cho, BS , Eom, KS , Kim, YJ , Lee, S , Kim, HJ , Min, CK , Cho, SG & Lee, JW 2019, 'Reactivation and dynamics of cytomegalovirus and Epstein-Barr virus after rabbit antithymocyte globulin and cyclosporine for aplastic anemia', European Journal of Haematology, vol. 103, no. 4, pp. 433-441. https://doi.org/10.1111/ejh.13308

TY - JOUR

T1 - Reactivation and dynamics of cytomegalovirus and Epstein-Barr virus after rabbit antithymocyte globulin and cyclosporine for aplastic anemia

AU - Park, Sung Soo

AU - Cho, Sung Yeon

AU - Han, Eunhee

AU - Min, Gi June

AU - Park, Silvia

AU - Yoon, Jae Ho

AU - Lee, Sung Eun

AU - Cho, Byung Sik

AU - Eom, Ki Seong

AU - Kim, Yoo Jin

AU - Lee, Seok

AU - Kim, Hee Je

AU - Min, Chang Ki

AU - Cho, Seok Goo

AU - Lee, Jong Wook

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Objectives: This study aimed to identify the natural course of cytomegalovirus (CMV)/Epstein-Barr virus (EBV) after rabbit antithymocyte globulin and cyclosporine (rATG-CsA) for aplastic anemia (AA). Methods: In 113 prospectively observed AA patients treated with rATG-CsA, the CMV/EBV cohort was classified into two groups by baseline viremic status: no viremia (CMV-G1, n = 112; EBV-G1, n = 98) and the presence of viremia (CMV-G2, n = 1; EBV-G2, n = 13). Results: In CMV-G1, the mean CMV load increased up to 3 months but was completely resolved from 6 months. The mean EBV load of EBV-G1 showed a peak at 1 month and then gradually decreased over time but remained detectable throughout the observation period. EBV-G2 showed fluctuating EBV dynamics. With reactivation rates of 38.4% in CMV-G1 and 62.2% in EBV-G1, a longer time to rATG-CsA from diagnosis and a lower absolute lymphocyte count at 1 month from rATG-CsA were significantly associated with CMV and EBV reactivation, respectively. The mean peak CMV and EBV loads of patients with CMV-related (3.5%) and EBV-related (0.9%) diseases were evidently higher than those of the remaining patients without CMV and EBV diseases in the respective cohort. Conclusion: Considering frequent reactivation and distinct courses of CMV/EBV, virologic surveillance is recommended after rATG-CsA for AA.

AB - Objectives: This study aimed to identify the natural course of cytomegalovirus (CMV)/Epstein-Barr virus (EBV) after rabbit antithymocyte globulin and cyclosporine (rATG-CsA) for aplastic anemia (AA). Methods: In 113 prospectively observed AA patients treated with rATG-CsA, the CMV/EBV cohort was classified into two groups by baseline viremic status: no viremia (CMV-G1, n = 112; EBV-G1, n = 98) and the presence of viremia (CMV-G2, n = 1; EBV-G2, n = 13). Results: In CMV-G1, the mean CMV load increased up to 3 months but was completely resolved from 6 months. The mean EBV load of EBV-G1 showed a peak at 1 month and then gradually decreased over time but remained detectable throughout the observation period. EBV-G2 showed fluctuating EBV dynamics. With reactivation rates of 38.4% in CMV-G1 and 62.2% in EBV-G1, a longer time to rATG-CsA from diagnosis and a lower absolute lymphocyte count at 1 month from rATG-CsA were significantly associated with CMV and EBV reactivation, respectively. The mean peak CMV and EBV loads of patients with CMV-related (3.5%) and EBV-related (0.9%) diseases were evidently higher than those of the remaining patients without CMV and EBV diseases in the respective cohort. Conclusion: Considering frequent reactivation and distinct courses of CMV/EBV, virologic surveillance is recommended after rATG-CsA for AA.

KW - Epstein-Barr virus

KW - aplastic anemia

KW - cytomegalovirus

KW - immunosuppressive therapy

KW - thymoglobulin

UR - http://www.scopus.com/inward/record.url?scp=85070995938&partnerID=8YFLogxK

U2 - 10.1111/ejh.13308

DO - 10.1111/ejh.13308

M3 - Article

C2 - 31381187

AN - SCOPUS:85070995938

SN - 0902-4441

VL - 103

SP - 433

EP - 441

JO - European Journal of Haematology

JF - European Journal of Haematology

IS - 4

ER -

Reactivation and dynamics of cytomegalovirus and Epstein-Barr virus after rabbit antithymocyte globulin and cyclosporine for aplastic anemia

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