Are the Polyomaviruses BK and JC Associated with Opportunistic Infections, Graft-versus-Host Disease, or Worse Outcomes in Adult Patients Receiving Their First Allogeneic Stem Cell Transplantation with Low-Dose Alemtuzumab?

Abstract

Background: The association of polyomaviruses BK and JC with other opportunistic infections and graft-versus-host disease (GvHD) in allogeneic stem cell transplantation is controversially discussed. Methods: We conducted a retrospective study of 64 adult patients who received their first allogeneic stem cell transplantation between March 2010 and December 2014; the follow-up time was 2 years. Results: Acute leukemia was the most frequent underlying disease (45.3%), and conditioning included myeloablative (67.2%) and nonmyeloablative protocols (32.8%). All patients received 10 mg of alemtuzumab on day -2 (20 mg in case of mismatch) as GvHD prophylaxis. Twenty-seven patients (41.5%) developed cytomegalovirus (CMV) reactivation. BKPyV-associated hemorrhagic cystitis was diagnosed in 10 patients (15.6%). Other opportunistic infections caused by viruses or protozoa occurred rarely (<10%). There was no association of BKPyV or JCPyV with CMV reactivation, Epstein-Barr virus reactivation, human herpes virus 6, or parvovirus B19 infection requiring treatment. There was a significant correlation of BKPyV-associated hemorrhagic cystitis with toxoplasmosis (p = 0.013). Additionally, there was a significant link of simultaneous BKPyV and JCPyV viruria with toxoplasmosis (p = 0.047). BKPyV and JCPyV were not associated with GvHD, relapse, or death. Conclusion: We found no association of BKPyV or JCPyV with viral infections or GvHD. Only the correlation of both polyomaviruses with toxoplasmosis was significant. This is a novel and interesting finding.

BK virus‐induced nephritis and cystitis after matched unrelated donor stem cell transplantation: A case report

“…Eighty percent of the general population has detectable antibodies against BK viruses, which persist in the body of those affected for life. [7][8][9] Transmission occurs by smear infection with urine, droplet infection, or contaminated drinking water. In immunocompromised patients, the BK virus can be reactivated or acquired primarily.…”

“…The tubular epithelial cells are often attacked, which can lead to tubulo-interstitial nephritis. 7,8 With significant morbidity, hemorrhagic BK virus cystitis occurs in about 13% (5%-25%) of patients early after stem cell transplantation. [11][12][13] Symptoms vary widely from mild dysuria, painless hematuria to painful hematuria or even severe hemorrhagic cystitis with intravesical coagulation and urethral obstruction and possible secondary renal failure.…”

“…Infection with the virus usually occurs in childhood with mild symptoms up to clinically blunt disease progression. Eighty percent of the general population has detectable antibodies against BK viruses, which persist in the body of those affected for life 7‐9 . Transmission occurs by smear infection with urine, droplet infection, or contaminated drinking water.…”

“…BK nephropathy can lead to gradual deterioration of renal function with an increase in serum creatinine concentration and, in kidney transplant recipients, even loss of the transplant. The tubular epithelial cells are often attacked, which can lead to tubulo‐interstitial nephritis 7,8 . With significant morbidity, hemorrhagic BK virus cystitis occurs in about 13% (5%‐25%) of patients early after stem cell transplantation 11‐13 .…”

Reactivation of Multiple Infectious Pathogens after Hematopoietic Stem Cell Transplantation

“…In the article by Schneidewind et al [1], the authors examined a retrospective collection of data from a single center. Over a 4-year period, they studied 64 adults with their first hematopoietic stem cell transplantation (HSCT) and collected follow-up data for up to 2 years.…”