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Infections

JC polyomavirus reactivation is common following allogeneic stem cell transplantation and its preemptive detection may prevent lethal complications

Bone Marrow Transplantation volume 50, pages 984–991 (2015)Cite this article

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Abstract

Extended application of allogeneic stem cell transplantation (alloSCT) is expected to increase the frequency of JC polyomavirus (JCPyV)-related progressive multifocal leukoencephalopathy (PML). The aim of this study was to assess frequency, risk factors and course of JCPyV reactivation in allografted hematology patients. This retrospective study included consecutive adult patients, treated with alloSCT between January 2008 and December 2011. Quantitative JCPyV-PCR analysis was performed on whole blood DNA samples, originally drawn for cytomegalovirus detection since transplant date. The study included 164 patients diagnosed with hematological malignancies. Patients received reduced-intensity conditioning (n=74) or myeloablative conditioning (n=90), followed by alloSCT. Twenty patients developed transient and 20 had persistent JCPyV reactivation. Two of the patients with persistent reactivation showed a gradual increase in JCPyV levels, preceding PML development by 96 and 127 days. Cessation of immunosuppression resulted in complete resolution of neurological symptoms in one patient, while the other died of PML. Seventy percent of the ‘persistently reactivating’ patients died. Multivariate analysis confirmed age to be the only significant predictive factor for JCPyV reactivation. In conclusion, JCPyV reactivation occurs in a quarter of allografted patients. Preemptive detection of JCPyV reactivation in high-risk subjects and early discontinuation of immunosuppressive therapy may prevent development of lethal PML.

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Acknowledgements

This article includes findings of the MD thesis conducted by Talya Wittmann in compliance with the requirements of the Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel for a Medical Doctor’s degree.

Author contributions

TW, NH and IA designed and performed the research, wrote the paper and approved the final version of the paper. NB, IH and TZ interpreted vital data, wrote the paper and approved the final version of the paper. JMR wrote the paper and approved the final version of the paper, ZK-O, MSC and IO interpreted vital data and approved the final version of the paper.

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Author notes

  1. T Wittmann and N Horowitz: These authors contributed equally to this work.

Authors and Affiliations

  1. Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel

    T Wittmann, N Horowitz, T Zuckerman, J M Rowe, Z Kra-Oz, I Oren & I Avivi

  2. Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

    N Horowitz, N Benyamini, I Henig, T Zuckerman, J M Rowe & I Avivi

  3. Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel

    J M Rowe

  4. Virology Laboratory, Rambam Health Care Campus, Haifa, Israel

    Z Kra-Oz & M Szwarcwort Cohen

  5. Unit of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel

    I Oren

  6. Department of Hematology and Bone Marrow Transplantation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    I Avivi

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  1. T Wittmann
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Correspondence to I Avivi.

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Wittmann, T., Horowitz, N., Benyamini, N. et al. JC polyomavirus reactivation is common following allogeneic stem cell transplantation and its preemptive detection may prevent lethal complications. Bone Marrow Transplant 50, 984–991 (2015). https://doi.org/10.1038/bmt.2015.68

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