Epstein-Barr virus (EBV) serology for predicting distant metastases in a white juvenile patient with nasopharyngeal carcinoma and no clinical response to EBV lytic induction therapy

Servi J C Stevens, Christian M Zwaan, Sandra A W M Verkuijlen, Jaap M Middeldorp

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: We describe a case of a 16-year-old white girl with Epstein-Barr virus (EBV)-positive nasopharyngeal carcinoma (NPC). METHODS.: At diagnosis, the patient had characteristic immunoglobulin (Ig)A and IgG responses to EBNA1, viral capsid antigen (VCA)-p18, and early antigens (EAs), with no detectable EBV DNA in her blood. Combined chemotherapy and radiotherapy resulted in complete remission. Eighteen months later, the patient's IgA responses to EBNA1 and p18 and both IgA and IgG anti-EA increased, without apparent recurrence. Five months later, lung metastases were found. She underwent surgical removal of the lung metastases and conventional chemotherapy, but had intraabdominal lymph node metastasis and mediastinal lesions develop. The patient was then treated with a novel treatment consisting of 5-fluorouracil plus valproic acid and subsequent valganciclovir to induce lytic EBV replication. This resulted in the first detectable EBV DNA levels in the blood but did not result in clinical response.

RESULTS: The patient's disease progressed, and the patient declined further cancer treatment and died.

CONCLUSION: In contrast to EBV DNA load, EBV serology was useful in predicting distant NPC metastasis after initial complete remission in this patient.

Original languageEnglish
Pages (from-to)1040-5
Number of pages6
JournalHead and Neck
Volume28
Issue number11
DOIs
Publication statusPublished - Nov 2006

Cite this

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title = "Epstein-Barr virus (EBV) serology for predicting distant metastases in a white juvenile patient with nasopharyngeal carcinoma and no clinical response to EBV lytic induction therapy",
abstract = "BACKGROUND: We describe a case of a 16-year-old white girl with Epstein-Barr virus (EBV)-positive nasopharyngeal carcinoma (NPC). METHODS.: At diagnosis, the patient had characteristic immunoglobulin (Ig)A and IgG responses to EBNA1, viral capsid antigen (VCA)-p18, and early antigens (EAs), with no detectable EBV DNA in her blood. Combined chemotherapy and radiotherapy resulted in complete remission. Eighteen months later, the patient's IgA responses to EBNA1 and p18 and both IgA and IgG anti-EA increased, without apparent recurrence. Five months later, lung metastases were found. She underwent surgical removal of the lung metastases and conventional chemotherapy, but had intraabdominal lymph node metastasis and mediastinal lesions develop. The patient was then treated with a novel treatment consisting of 5-fluorouracil plus valproic acid and subsequent valganciclovir to induce lytic EBV replication. This resulted in the first detectable EBV DNA levels in the blood but did not result in clinical response.RESULTS: The patient's disease progressed, and the patient declined further cancer treatment and died.CONCLUSION: In contrast to EBV DNA load, EBV serology was useful in predicting distant NPC metastasis after initial complete remission in this patient.",
keywords = "Adolescent, Antibodies, Viral, Fatal Outcome, Female, Herpesvirus 4, Human, Humans, Immunoglobulin A, Immunoglobulin G, Lung Neoplasms, Lymphatic Metastasis, Nasopharyngeal Neoplasms, Neoplasm Metastasis, Serologic Tests, Case Reports, Journal Article",
author = "Stevens, {Servi J C} and Zwaan, {Christian M} and Verkuijlen, {Sandra A W M} and Middeldorp, {Jaap M}",
year = "2006",
month = "11",
doi = "10.1002/hed.20466",
language = "English",
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pages = "1040--5",
journal = "Head and Neck",
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Epstein-Barr virus (EBV) serology for predicting distant metastases in a white juvenile patient with nasopharyngeal carcinoma and no clinical response to EBV lytic induction therapy. / Stevens, Servi J C; Zwaan, Christian M; Verkuijlen, Sandra A W M; Middeldorp, Jaap M.

In: Head and Neck, Vol. 28, No. 11, 11.2006, p. 1040-5.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Epstein-Barr virus (EBV) serology for predicting distant metastases in a white juvenile patient with nasopharyngeal carcinoma and no clinical response to EBV lytic induction therapy

AU - Stevens, Servi J C

AU - Zwaan, Christian M

AU - Verkuijlen, Sandra A W M

AU - Middeldorp, Jaap M

PY - 2006/11

Y1 - 2006/11

N2 - BACKGROUND: We describe a case of a 16-year-old white girl with Epstein-Barr virus (EBV)-positive nasopharyngeal carcinoma (NPC). METHODS.: At diagnosis, the patient had characteristic immunoglobulin (Ig)A and IgG responses to EBNA1, viral capsid antigen (VCA)-p18, and early antigens (EAs), with no detectable EBV DNA in her blood. Combined chemotherapy and radiotherapy resulted in complete remission. Eighteen months later, the patient's IgA responses to EBNA1 and p18 and both IgA and IgG anti-EA increased, without apparent recurrence. Five months later, lung metastases were found. She underwent surgical removal of the lung metastases and conventional chemotherapy, but had intraabdominal lymph node metastasis and mediastinal lesions develop. The patient was then treated with a novel treatment consisting of 5-fluorouracil plus valproic acid and subsequent valganciclovir to induce lytic EBV replication. This resulted in the first detectable EBV DNA levels in the blood but did not result in clinical response.RESULTS: The patient's disease progressed, and the patient declined further cancer treatment and died.CONCLUSION: In contrast to EBV DNA load, EBV serology was useful in predicting distant NPC metastasis after initial complete remission in this patient.

AB - BACKGROUND: We describe a case of a 16-year-old white girl with Epstein-Barr virus (EBV)-positive nasopharyngeal carcinoma (NPC). METHODS.: At diagnosis, the patient had characteristic immunoglobulin (Ig)A and IgG responses to EBNA1, viral capsid antigen (VCA)-p18, and early antigens (EAs), with no detectable EBV DNA in her blood. Combined chemotherapy and radiotherapy resulted in complete remission. Eighteen months later, the patient's IgA responses to EBNA1 and p18 and both IgA and IgG anti-EA increased, without apparent recurrence. Five months later, lung metastases were found. She underwent surgical removal of the lung metastases and conventional chemotherapy, but had intraabdominal lymph node metastasis and mediastinal lesions develop. The patient was then treated with a novel treatment consisting of 5-fluorouracil plus valproic acid and subsequent valganciclovir to induce lytic EBV replication. This resulted in the first detectable EBV DNA levels in the blood but did not result in clinical response.RESULTS: The patient's disease progressed, and the patient declined further cancer treatment and died.CONCLUSION: In contrast to EBV DNA load, EBV serology was useful in predicting distant NPC metastasis after initial complete remission in this patient.

KW - Adolescent

KW - Antibodies, Viral

KW - Fatal Outcome

KW - Female

KW - Herpesvirus 4, Human

KW - Humans

KW - Immunoglobulin A

KW - Immunoglobulin G

KW - Lung Neoplasms

KW - Lymphatic Metastasis

KW - Nasopharyngeal Neoplasms

KW - Neoplasm Metastasis

KW - Serologic Tests

KW - Case Reports

KW - Journal Article

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JO - Head and Neck

JF - Head and Neck

SN - 1043-3074

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ER -