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Persistent polyomavirus-associated nephropathy in a patient with GvHD and treatment with the JAK1/2 inhibitor ruxolitinib

Bone Marrow Transplantation volume 54, pages 762–764 (2019)Cite this article

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Chronic graft-versus-host disease (cGvHD) is a frequent complication upon allogenic stem cell transplantation (alloHSCT), which is potentially life threatening and restricts the quality of life. Beyond others, ruxolitinib (Jakavi®), a Janus kinase (JAK) 1/2 inhibitor, approved for the treatment of primary myelofibrosis and polycythemia vera, has been shown to positively affect symptoms of steroid-resistant acute and chronic GvHD [1,2,3]. Janus-associated kinases 1 and 2 are involved in signal transduction of cytokine receptors such as interferon-ɣ and interleukin-6 receptor, and thereby contribute to inflammatory processes. However, inhibition of Janus-associated kinases severely modulates and thereby also compromises the immune response, potentially leading to opportunistic infections such as fatal viral reactivations [4].

We report the case of a male patient who underwent a matched unrelated donor peripheral blood stem cell transplantation (mUD-PBSCT) for treatment of acute myeloid leukemia in 1st remission at the age of 48. Upon an uncomplicated transplantation the patient developed a steroid-responsive (initial dose 2.5 mg/kg/day prednisolone) acute GvHD of the skin (overall grade 3) on day 10. During tapering of immunosuppression, a single episode of Coombs-positive hemolytic anemia on day 90 was successfully treated with 1 mg/kg/day prednisolone and a single dose of rituximab. Subsequently, immunosuppression with steroids and tacrolimus was tapered and terminated on day 222.

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Acknowledgements

The authors would like to thank Jasmin Klein (Institute of Clinical Microbiology and Hygiene) for her excellent technical assistance.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Internal Medicine III, University Medical Center, Regensburg, Germany

    Matthias A. Fante, Ernst Holler & Daniel Wolff

  2. Institute of Medical Microbiology and Hygiene, Department of Virology, University of Regensburg, Regensburg, Germany

    Barbara Schmidt & Annelie Plentz

  3. Institute of Clinical Microbiology and Hygiene, Clinical Virology and Infection Immunology, University Medical Center, Regensburg, Germany

    Barbara Schmidt

  4. Department of Nephrology, Internal Medicine II, University Medical Center, Regensburg, Germany

    Yvonne Ehrl

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  1. Matthias A. Fante
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Correspondence to Matthias A. Fante.

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Fante, M.A., Holler, E., Schmidt, B. et al. Persistent polyomavirus-associated nephropathy in a patient with GvHD and treatment with the JAK1/2 inhibitor ruxolitinib. Bone Marrow Transplant 54, 762–764 (2019). https://doi.org/10.1038/s41409-018-0370-7

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