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Donor lymphocyte infusion for BK virus hemorrhagic cystitis and nephropathy: a case report

Bone Marrow Transplantation volume 54, pages 772–774 (2019)Cite this article

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BK virus (BKV) is a member of the polyomavirus family (polyomavirus hominis type I), highly prevalent in humans. It is ubiquitous and the primary infection is largely asymptomatic, occurring mostly during childhood. Thereafter, the virus remains latent predominantly in the urinary tract. In immunocompromised patients, lacking appropriate immune surveillance, it has been observed that BKV replicates, causing hemorrhagic cystitis (HC) [1] and nephropathy after allogeneic hematopoietic cell transplant (AlloHCT) [2]. Treatment for BKV HC includes supportive approach, anti-viral treatment, and unspecific immunoglobulin [2]. Other approaches, such as the use of estrogens or the hyperbaric oxygen therapy have been also tested, with results that need further confirmation [3]. Grade III–IV BKV HC is a severe life-threatening complication that requires a complex and multidisciplinary approach. Hence there is therefore an unmet clinical need for different therapeutic approaches in unresponsive BKV infection.

Donor lymphocyte infusions (DLIs) are transfusions of CD3+ cells from the donor, broadly used as a preemptive, prophylactic or therapeutic approach after AlloHCT. Its graft-versus-tumor effect has been reported in several hematological malignancies [4]. Further, DLIs have also been successfully used as anti-infectious therapy. In this context, the Memorial Sloan-Kettering Cancer Center published a seminal paper describing a cohort of AlloHCT patients diagnosed with Epstein–Barr virus (EBV)-related lymphoprolipherative disease (LPD) responding to DLI, outlining the anti-EBV effect of DLI [5]. However, given the potential risk of graft-versus-host disease (GVHD), its use has been reserved for severe infections where other strategies failed.

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Author notes

  1. These authors contributed equally: Guillermo Ortí, Gloria Iacoboni

Authors and Affiliations

  1. Hematology Department. Hospital Universitari Vall d’Hebron, VHIO, Departament de Medicina. Universitat Autònoma de Barcelona, Barcelona, Spain

    Guillermo Ortí, Gloria Iacoboni, Pere Barba, Elisa Roldán, Laura Fox, Olga Salamero, Francesc Bosch & David Valcárcel

  2. Servei d’Immunologia, Hospital del Mar, Institut Hospital del Mar de Investigacions Médiques-IMIM, Barcelona, Spain

    Ramón Gimeno

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Contributions

GO, and GI: conception and design of the study, analysis and interpretation of data, drafting the article. GI, DV and GI revising the paper critically for important intellectual content and final approval of the version to be published. All authors: analysis and interpretation of data, revising the article critically for important intellectual content, and final approval of the version to be published.

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Correspondence to Guillermo Ortí.

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Ortí, G., Iacoboni, G., Barba, P. et al. Donor lymphocyte infusion for BK virus hemorrhagic cystitis and nephropathy: a case report. Bone Marrow Transplant 54, 772–774 (2019). https://doi.org/10.1038/s41409-018-0402-3

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