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<p>Alemtuzumab, a humanized monoclonal antibody against CD52, is approved for graft-versus-host disease (GVHD) prophylaxis in allogeneic hematopoietic stem cell transplantation (allo-HSCT) due to its strong immunosuppressive effects. We report the case of a 26-year-old woman with systemic chronic active Epstein–Barr virus disease (sCAEBV) who underwent allo-HSCT from an HLA-matched sibling donor with alemtuzumab-based GVHD prophylaxis. Her EBV-infected cells were CD4-positive T cells. Flow cytometry revealed an expansion of CD52-expressing CD4-positive T cells in peripheral blood (PB) with elevated EBV-DNA load. After treatment with alemtuzumab (0.16&#xa0;mg/kg on Days  – 10 and  – 9), the CD4-positive cell fraction in PB declined rapidly, while EBV-DNA simultaneously decreased to an undetectable level. The conditioning regimen consisted of fludarabine (25&#xa0;mg/m<sup>2</sup>, Days  – 7 to  – 3), melphalan (40&#xa0;mg/m<sup>2</sup>, Days  – 3 to  – 2), and total body irradiation (TBI, 4&#xa0;Gy, Day  – 1). The serum concentration of alemtuzumab at transplantation was 0.36&#xa0;μg/mL. Cyclosporine was given from Day  – 1, and short-term methotrexate was given on Days 1, 3, and 6. The transplantation was successful, with no GVHD or severe infections. Earlier administration of alemtuzumab may not only reduce prolonged post-transplant immunosuppression but also speed up elimination of EBV-infected cells before transplantation for sCAEBV.</p>

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Targeting EBV-infected T cells with alemtuzumab: a novel approach to systemic chronic active EBV disease

  • 期刊论文

  • 发表日期：

    2025年4月30日

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  • Keimi Segami,
  • Akihiro Yokoyama,
  • Ayaka Ohashi,
  • Kana Matsumoto,
  • Aika Fuseya,
  • Hayato Tamai,
  • Kumi Oshima,
  • Fumiaki Sano,
  • Ayako Arai

摘要

Alemtuzumab, a humanized monoclonal antibody against CD52, is approved for graft-versus-host disease (GVHD) prophylaxis in allogeneic hematopoietic stem cell transplantation (allo-HSCT) due to its strong immunosuppressive effects. We report the case of a 26-year-old woman with systemic chronic active Epstein–Barr virus disease (sCAEBV) who underwent allo-HSCT from an HLA-matched sibling donor with alemtuzumab-based GVHD prophylaxis. Her EBV-infected cells were CD4-positive T cells. Flow cytometry revealed an expansion of CD52-expressing CD4-positive T cells in peripheral blood (PB) with elevated EBV-DNA load. After treatment with alemtuzumab (0.16 mg/kg on Days  – 10 and  – 9), the CD4-positive cell fraction in PB declined rapidly, while EBV-DNA simultaneously decreased to an undetectable level. The conditioning regimen consisted of fludarabine (25 mg/m2, Days  – 7 to  – 3), melphalan (40 mg/m2, Days  – 3 to  – 2), and total body irradiation (TBI, 4 Gy, Day  – 1). The serum concentration of alemtuzumab at transplantation was 0.36 μg/mL. Cyclosporine was given from Day  – 1, and short-term methotrexate was given on Days 1, 3, and 6. The transplantation was successful, with no GVHD or severe infections. Earlier administration of alemtuzumab may not only reduce prolonged post-transplant immunosuppression but also speed up elimination of EBV-infected cells before transplantation for sCAEBV.