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XMRV: Virological, immunological and clinical correlations in a

patient with Chronic Lymphocytic Leukemia Abstract #109 
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Background Results Results Continued Conclusions

XMRV has recently been identified in patients with prostate ´CFS patients who subsequently developed  T cell
cancer and Chronic Fatigue Syndrome (CFS). CFS patients clonalities and cancer were tested for XMRV infection (Table 

have an increased incidence of lymphoproliferative 1).
malignancy compared to the normal population. While the Cytokine signature of patients with developed  T cell
incidence rate of non-Hodgkin¶s lymphoma is 0.02% in the clonalaties and cancer (Figure 1)  

United States, nearly 5% of CFS patients developed the ´B Cells developed from patients with CLL or MCL express 

disease. To address this, we identified several XMRV XMRV and these cell lines produce infectious XMRV (Figure

infected CFS patients who subsequently developed Chronic 2A,B).


Lymphocytic Leukemia (CLL) and Mantle Cell Lymphoma ´By flow cytometry, the immunophenotype was compatible
(MCL). Treatment of XMRV associated neoplasia has not with MCL and CLL respectively (i.e. CD5+CD20+CD23- 

been previously reported. However, HTLV-1 associated T- FMC7+) and (CD5+ CD20+ CD23+FMC7). (Table 2) Figure 1. Random Forest generated Cytokine and Chemokine pattern consistent with XMRV
infection. Red bars indicated relative importance of each cytokine to delineate CFS related XMRV
cell lymphoma/leukemia responds to zidovudine (AZT) and ´A patient with a 3 year history of untreated CLL and infection. The 10 most significant are shown from a panel of 25 different cytokines and
IFN Y. In addition, multiple human tumor cell lines including symptoms consistent with CFS was identified as having
chemokines measured on a Luminex platform.                      

breast cancer show growth inhibition and apoptosis when XMRV plasma viremia by the methods of Lombardi et al. (not
exposed to AZT. Several groups have reported inhibition of shown) and his lymphocytes were positive for XMRV as
Figure 4. Time course showing the resolution of inflammatory cytokine and chemokine profile
following antiretroviral therapy
XMRV by FDA approved antiretrovirals including measured by the DERSE assay. (Figure 2B). The first 100
AZT, Raltegravir, and Tenofovir in cell culture. Our study days of treatment showed improvement in the ALC, trisomy
 Ä  Ä 

investigated XMRV associated malignancy other than 12 clone and symptoms of CFS. Preliminary data after the

prostate cancer, including CLL and MCL and the effect of first 100 days suggest that the ALC and trisomy 12 clone

antiretroviral treatment on the various parameters of a patient have started to rise again (Figure 5) but symptoms of CFS

with CFS and CLL. continue to be minimal. Studies are ongoing to confirm these

results and the mechanisms involved.
Figure 2A. Flow cytometry analysis of B cells from CLL and MCL patients . Cells are uuu
´The infectious XMRV viral load and the inflammatory visualized by intracellular staining with FITC conjugated anti SFFV envelope antibodies.  Ä()   

Methods cytokine-chemokine signature improved in parallel with the uuu

ALC and trisomy 12 clone following initiation of antiretroviral uuu

therapy (Figures 3, 4 and 5 respectively). uuu

´Peripheral blood mononuclear cells were isolated, and the u

uu uu uu uu uu uu uu uu uu uuu uu  uu uu

CLL cells shown to be infected by intracellular staining of !   Ä

antibodies to XMRV Gag and Env and infectious virus Figure 5. Time course of antiretroviral therapy showing total CLL. Lines of best fit are applied to
data to estimate doubling times.
isolated from blood by methods developed in our lab
(Lombardi et. Al. Science 2009). A patient with CFS and CLL with adverse prognostic
Figure 2B (above) Infection was
factors was shown to have XMRV in plasma and CLL
´Cytokine profiles were determined on plasma by multiplex transferred from patient derived cells. Within the first 100 days of treatment with AZT and
analysis of 30 cytokines, chemokines, and growth factors on cell lines to DERSE indicator cell
raltegravir, he showed multiple benefits simultaneous
line, in which GFP is expressed by
a Luminex platform. reverse transcriptase activity. Table with disappearance of infectious XMRV. These findings
2 (right) surface marker phenotype
of cell lines derived from CFS suggest that XMRV is etiological for both the CLL and
´Immune cell phenotyping was performed by multiparameter patients who subsequently
CFS and that virus-direct treatment was beneficial in
developed CLL and MCL.
flow cytometry on an LSR2 flow cytometer. this patient. Further CLL patients should be studied
especially as CLL has been statistically associated with
´Absolute lymphocyte counts (ALC) were determined on a an increased risk for other neoplasia. Questions to be
LH 750 Coulter Analyzer with a 200 cell manual differential. answered are what neoplasms are associated with
XMRV, will existing antiretrovirals have antineoplastic
´Trisomy 12 percentages were determined by FISH (Quest activity in these neoplasms and what is the optimal
Diagnostics) and multiplied by the ALC to determine absolute combination of antiretroviral drugs.
Author Information
1SUNY Buffalo, Medicine, Buffalo, NY, USA
Table 1. CFS patients who subsequently developed  T cell rearrangements and cancer. 2Whittemore Peterson Institute for Neuro-Immune

Figure 3. Flow cytometry analysis of virus infected indicator cells pre and post antiretroviral Disease, Applied Research Facility, Reno, NV, USA
treatment. 3Center for Cancer Research NCI-Frederick, Basic

Research Laboratory, Frederick, MD, USA

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