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Case Reports
. 2025 Aug;122(2):305-309.
doi: 10.1007/s12185-025-03988-0. Epub 2025 Apr 30.

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

Keimi Segami  1   2 , Akihiro Yokoyama  3 , Ayaka Ohashi  4 , Kana Matsumoto  5 , Aika Fuseya  1 , Hayato Tamai  1 , Kumi Oshima  1 , Fumiaki Sano  1 , Ayako Arai  6
Affiliations
Case Reports

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

Keimi Segami et al. Int J Hematol. 2025 Aug.

Abstract

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.

Keywords: Alemtuzumab; CD52; Hematopoietic stem cell transplantation; sCAEBV.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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