title: JC polyomavirus reactivation is common following allogeneic stem cell transplantation and its preemptive detection may prevent lethal complications.
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.
authors: Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors: T
authors: T
authors: Wittmann
authors: 1] Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel [2] Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
authors: N
authors: N
authors: Horowitz
authors: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
authors: N
authors: N
authors: Benyamini
authors: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
authors: I
authors: I
authors: Henig
authors: 1] Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel [2] Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
authors: T
authors: T
authors: Zuckerman
authors: 1] Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel [2] Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel [3] Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel.
authors: J M
authors: JM
authors: Rowe
authors: 1] Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel [2] Virology Laboratory, Rambam Health Care Campus, Haifa, Israel.
authors: Z
authors: Z
authors: Kra-Oz
authors: Virology Laboratory, Rambam Health Care Campus, Haifa, Israel.
authors: M
authors: M
authors: Szwarcwort Cohen
authors: 1] Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel [2] Unit of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.
authors: I
authors: I
authors: Oren
authors: 1] Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel [2] Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel [3] Department of Hematology and Bone Marrow Transplantation, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors: I
authors: I
authors: Avivi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007577:JC Virus / Q000472:pathogenicity*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000821:virology*; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult