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Characterization and treatment of chronic active Epstein-Barr virus disease: a 28-year experience in the United States by Jeffrey I. Cohen, Elaine S. Jaffe,

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Presentation on theme: "Characterization and treatment of chronic active Epstein-Barr virus disease: a 28-year experience in the United States by Jeffrey I. Cohen, Elaine S. Jaffe,"— Presentation transcript:

1 Characterization and treatment of chronic active Epstein-Barr virus disease: a 28-year experience in the United States by Jeffrey I. Cohen, Elaine S. Jaffe, Janet K. Dale, Stefania Pittaluga, Helen E. Heslop, Cliona M. Rooney, Stephen Gottschalk, Catherine M. Bollard, V. Koneti Rao, Adriana Marques, Peter D. Burbelo, Siu-Ping Turk, Rachael Fulton, Alan S. Wayne, Richard F. Little, Mitchell S. Cairo, Nader K. El-Mallawany, Daniel Fowler, Claude Sportes, Michael R. Bishop, Wyndham Wilson, and Stephen E. Straus Blood Volume 117(22): June 2, 2011 ©2011 by American Society of Hematology

2 EBV RNA in both CD20+ and CD20− B cells in a lymph node from patient 16.
EBV RNA in both CD20+ and CD20− B cells in a lymph node from patient 16. (A) Lymph node biopsy shows polymorphic B-cell lymphoma. (B) In situ hybridization shows that the tumor cells are positive for EBER. Few cells express the CD20 B-cell marker (C), whereas many cells express the CD3 T-cell (D), CD79 B-cell (E), and Pax-5 B-cell (F) markers. Jeffrey I. Cohen et al. Blood 2011;117: ©2011 by American Society of Hematology

3 EBV disease involving skin, lymph nodes, and spleen.
EBV disease involving skin, lymph nodes, and spleen. Skin from patient 12 shows a perivascular lymphocytic infiltrate (A) that is positive for EBER (B). Lymph node (C) and spleen (D) with hemophagocytosis from patient 9. Jeffrey I. Cohen et al. Blood 2011;117: ©2011 by American Society of Hematology

4 Levels of antibody to EBV lytic proteins and EBNA1 by the luciferase immunoprecipitation system assay in EBV-seropositive control patients (CTRL), patients with CAEBV, and EBV-seronegative control patients. Levels of antibody to EBV lytic proteins and EBNA1 by the luciferase immunoprecipitation system assay in EBV-seropositive control patients (CTRL), patients with CAEBV, and EBV-seronegative control patients. Each point represents an individual sample from an uninfected control or a person infected with EBV. Antibody titers are expressed in LU. P values were calculated with the Mann-Whitney U test. The solid horizontal lines indicate the geometric mean antibody titers in each group, and the vertical lines show the 95% confidence interval. Jeffrey I. Cohen et al. Blood 2011;117: ©2011 by American Society of Hematology

5 Cytokine levels in patients with CAEBV
Cytokine levels in patients with CAEBV. Levels of IL-6, IL-10, TNF-α, and IFN-γ are shown in pg/mL. Cytokine levels in patients with CAEBV. Levels of IL-6, IL-10, TNF-α, and IFN-γ are shown in pg/mL. CTRL indicates healthy EBV-seropositive control patients; B, patients with B-cell CAEBV; B + T, combined patients with B-cell and T-cell CAEBV. Jeffrey I. Cohen et al. Blood 2011;117: ©2011 by American Society of Hematology

6 Clinical course. Clinical course. Clinical course for patients 12 (A) and 17 (B) is shown. Time from initial clinic visit is shown on the x-axis and EBV DNA viral load is on the y-axis. Chemo indicates chemotherapy; EPOCH-RF, etoposide-vincristine-doxorubicin-cyclophosphamide-prednisone-rituximab-fludarabine. Jeffrey I. Cohen et al. Blood 2011;117: ©2011 by American Society of Hematology


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