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Chang A, Sholukh AM, Wieland A, Jaye DL, Carrington M, Huang ML, Xie H, Jerome KR, Roychoudhury P, Greninger AL, Koff JL, Cohen JB, Koelle DM, Corey L, Flowers CR, Ahmed R. Herpes simplex virus lymphadenitis is associated with tumor reduction in a chronic lymphocytic leukemia patient. J Clin Invest 2022; 132:161109. [PMID: 35862190 PMCID: PMC9479599 DOI: 10.1172/jci161109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Herpes simplex virus lymphadenitis (HSVL) is an unusual presentation of HSV reactivation in chronic lymphocytic leukemia (CLL) patients characterized by systemic symptoms and no herpetic lesions. The immune responses during HSVL have not been studied. METHODS Peripheral blood and lymph node samples of a patient with HSVL were obtained. HSV-2 viral load, antibody levels, B and T cell responses, cytokine levels, and tumor burden were measured. RESULTS This patient showed HSV-2 viremia for at least 6 weeks. During this period, she had a robust HSV-specific antibody response with neutralizing and antibody-dependent cellular phagocytosis activity. Activated (HLA-DR+, CD38+) CD4+ and CD8+ T cells increased 18-fold and HSV-specific CD8+ T cells were detected in the blood at higher numbers. HSV-specific B and T cell responses in the lymph node were also detected. Markedly elevated levels of pro-inflammatory cytokines in the blood were also observed. Surprisingly, a sustained decrease in CLL tumor burden without CLL-directed therapy was observed with this and also a prior episode of HSVL. CONCLUSION HSVL should be considered as part of the differential diagnosis in CLL patients who present with signs and symptoms of aggressive lymphoma transformation. An interesting finding was the sustained tumor control after 2 episodes of HSVL in this patient. This tumor burden reduction may be due to the HSV-specific response serving as an adjuvant for activating tumor-specific or bystander T cells. Studies in additional CLL patients are needed to confirm and extend these findings. FUNDING National Institutes of Health and Winship Cancer Institute.
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Affiliation(s)
- Andres Chang
- Winship Cancer Institute of Emory University, Atlanta, United States of America
| | - Anton M Sholukh
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, United States of America
| | - Andreas Wieland
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, United States of America
| | - David L Jaye
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
| | - Mary Carrington
- Laboratory of Experimental Immunology, Frederick National Laboratory for Cancer Research, Bethesda, United States of America
| | - Meei-Li Huang
- University of Washington, Seattle, United States of America
| | - Hong Xie
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, United States of America
| | - Keith R Jerome
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, United States of America
| | - Pavitra Roychoudhury
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, United States of America
| | - Alexander L Greninger
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, United States of America
| | - Jean L Koff
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, United States of America
| | - Jonathon B Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, United States of America
| | - David M Koelle
- Department of Global Health, University of Washington, Seattle, United States of America
| | - Lawrence Corey
- Fred Hutchinson Cancer Research Center, Seattle, United States of America
| | - Christopher R Flowers
- Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, United States of America
| | - Rafi Ahmed
- Emory University School of Medicine, Atlanta, United States of America
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