Quantifing the Circulating Epstein-Barr Virus (EBV) DNA to Monitor a Case of Aggressive Natural Killer Cell Leukemia

Seong Yoon Yi; Hyo Song Kim; Hyun Jung Jun; Ji Hyun Yang; Young H. Ko; Chang-Seok Ki; Won Seog Kim

doi:10.5045/kjh.2007.42.2.167

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Yi, Kim, Jun, Yang, Ko, Ki, and Kim: Quantifing the Circulating Epstein-Barr Virus (EBV) DNA to Monitor a Case of Aggressive Natural Killer Cell Leukemia

Case Report

Korean J Hematol 2007;42(2):167-171.

Published online: 19 June 2007

DOI: https://doi.org/10.5045/kjh.2007.42.2.167

Quantifing the Circulating Epstein-Barr Virus (EBV) DNA to Monitor a Case of Aggressive Natural Killer Cell Leukemia

Seong Yoon Yi, M.D.¹, Hyo Song Kim, M.D.¹, Hyun Jung Jun, M.D.¹, Ji Hyun Yang, M.D.¹, Young H. Ko, M.D.², Chang-Seok Ki, M.D.³, Won Seog Kim, M.D.^1,

¹Department of Internal Medicine, Seoul, Korea

²Department of Pathology, Seoul, Korea

³Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to：Won Seog Kim, M.D. Department of Internal Medicine, Samsung Medicil Center, Sungkyunkwon University School of Medicine 50, Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: ＋82-3410-6548, Fax: ＋82-3410-0041 E-mail: wskimsmc@smc.samsung.co.kr

Received 22 March 2007 Revised 30 March 2007 Accepted 29 May 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Epstein-Barr virus (EBV) infection is associated with various lymphoproliferative diseases, including Hodgkin lymphoma, extranodal NK/T cell lymphoma, aggressive NK cell leukemia, Burkitt lymphoma and post-transplant lymphoproliferative disorder. In the recent studies, the plasma EBV-DNA levels in patients with EBV-associated lymphoproliferative disease appeared to be correlated with the therapeutic response. Aggressive NK cell leukemia (ANKL) is a fatal disease that's characterized by high fever, lymphadenopathy, hepatosplenomegaly and frequent hemophagocytosis. No serological tumor marker for this malignancy has yet been identified for monitoring the disease and predicting the outcome. We experienced a case of aggressive natural killer cell leukemia in a 48-year-old man, and we serially monitored the plasma EBV DNA load by performing real time quantitative PCR assay. Serial measurements of the plasma EBV DNA level during therapy showed a close correlation between the clinical response and the changes in the plasma EBV DNA titers.

Keywords: Aggressive natural killer cell leukemia (ANKL), Epstein Barr virus (EBV), Real time quantitative PCR

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Fig. 1

The bone marrow shows focal infiltration by monotonous neoplastic cells, which are admixed with hemophagocytic histiocytes (arrow) (H&E stain, ×400).

Fig. 2

(A) The neoplastic cells are positive for CD 56 (arrow) (immunohistochemisty, ×100), (B) In situ hybridization for EBV shows staining of tumor cells (arrows) (EBV-ISH, ×400).

Fig. 3

Serial measurements of plasma EBV DNA level during therapy showed a close correlation between EBV-DNA titer and liver function test (total bilirubin, AST, LDH).

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