M Toyoda1, D Thomas1, G Ahn1, J Kahwaji2, J Mirocha3, M Chu1, A Vo2, E Suviolahti1, S Ge1, S C Jordan2. 1. Transplant Immunology Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA. 2. Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA. 3. Biostatistics Core, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Abstract
BACKGROUND: Desensitization (DES) with intravenous immunoglobulin (IVIG) + rituximab is effective, safe, and increases the transplantation rate in human leukocyte antigen-sensitized patients. However, reports of progressive multifocal leukoencephalopathy (PML) caused by JC polyomavirus (JCPyV) in autoimmune patients treated with rituximab is concerning. Here, we report on the JCPyV viremia and PML status in kidney transplant patients with/without DES (non-DES). METHODS: In total 1195 and 699 DNA samples from plasma in 117 DES (78% lymphocyte-depleting [LyD] induction) and 100 non-DES patients (45% LyD), respectively, were submitted for JCPyV-polymerase chain reaction. Results were compared in both groups. RESULTS: No patients in either DES or non-DES developed PML or presented with any neurological symptoms. The JCPyV viremia rate was similar in DES and non-DES patients (3/117 vs. 9/100, P = 0.07). The JCPyV levels were low (median peak levels, 1025 copies/mL) and JCPyV viremia was observed only once during the study period in most patients. All 3 DES patients with JCPyV(+) received 1 dose rituximab and no DES patients with >1 dose rituximab showed JCPyV(+). All 3 JCPyV(+) DES patients received LyD induction, while only 2 of 9 JCPyV(+) non-DES patients did so, and the remaining 7 received non-LyD or no induction. JCPyV in leukocyte was mostly negative in DES and non-DES patients. Immunosuppression in patients with or without JCPyV(+) was similar. BK polyomavirus viremia was observed more commonly in patients with JCPyV(+) than in those without (P < 0.02). CONCLUSIONS: Patients with IVIG + rituximab DES followed by transplantation with LyD induction and additional rituximab rarely show JCPyV viremia and appear at low risk for PML.
BACKGROUND: Desensitization (DES) with intravenous immunoglobulin (IVIG) + rituximab is effective, safe, and increases the transplantation rate in human leukocyte antigen-sensitized patients. However, reports of progressive multifocal leukoencephalopathy (PML) caused by JC polyomavirus (JCPyV) in autoimmunepatients treated with rituximab is concerning. Here, we report on the JCPyV viremia and PML status in kidney transplant patients with/without DES (non-DES). METHODS: In total 1195 and 699 DNA samples from plasma in 117 DES (78% lymphocyte-depleting [LyD] induction) and 100 non-DESpatients (45% LyD), respectively, were submitted for JCPyV-polymerase chain reaction. Results were compared in both groups. RESULTS: No patients in either DES or non-DES developed PML or presented with any neurological symptoms. The JCPyV viremia rate was similar in DES and non-DESpatients (3/117 vs. 9/100, P = 0.07). The JCPyV levels were low (median peak levels, 1025 copies/mL) and JCPyV viremia was observed only once during the study period in most patients. All 3 DESpatients with JCPyV(+) received 1 dose rituximab and no DESpatients with >1 dose rituximab showed JCPyV(+). All 3 JCPyV(+) DESpatients received LyD induction, while only 2 of 9 JCPyV(+) non-DESpatients did so, and the remaining 7 received non-LyD or no induction. JCPyV in leukocyte was mostly negative in DES and non-DESpatients. Immunosuppression in patients with or without JCPyV(+) was similar. BK polyomavirus viremia was observed more commonly in patients with JCPyV(+) than in those without (P < 0.02). CONCLUSIONS:Patients with IVIG + rituximabDES followed by transplantation with LyD induction and additional rituximab rarely show JCPyV viremia and appear at low risk for PML.
Authors: Irene K Kim; Jua Choi; Ashley A Vo; Alexis Kang; Mitasha Patel; Mieko Toyoda; James Mirocha; Elaine S Kamil; J Louis Cohen; Sabrina Louie; Odette Galera; Stanley C Jordan; Dechu P Puliyanda Journal: Transplantation Date: 2017-04 Impact factor: 4.939
Authors: Mieko Toyoda; Bong-Ha Shin; Shili Ge; James Mirocha; David Thomas; Maggie Chu; Edgar Rodriguez; Christine Chao; Anna Petrosyan; Odette A Galera; Ashley Vo; Jua Choi; Alice Peng; Joseph Kahwaji; Stanley C Jordan Journal: J Immunol Res Date: 2017-02-06 Impact factor: 4.818