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Poor immune reconstitution is associated with symptomatic BK polyomavirus viruria in allogeneic stem cell transplant recipients
Author(s) -
Abudayyeh Ala,
Hamdi Amir,
Abdelrahim Maen,
Lin Heather,
Page Valda D.,
Rondon Gabriela,
Andersson Borje S.,
Afrough Aimaz,
Martinez Charles S.,
Tarrand Jeffrey J.,
Kontoyiannis Dimitrios P.,
Marin David,
Gaber A. Osama,
Oran Betul,
Chemaly Roy F.,
Ahmed Sairah,
Abudayyeh Islam,
Olson Amanda,
Jones Roy,
Popat Uday,
Champlin Richard E.,
Shpall Elizabeth J.,
Rezvani Katayoun
Publication year - 2017
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12632
Subject(s) - medicine , immune system , proportional hazards model , gastroenterology , hematopoietic stem cell transplantation , transplantation , immunosuppression , hazard ratio , immunology , confidence interval
Background BK polyomavirus ( BKP yV) infections are known indicators of immune suppression in hematopoietic stem cell transplant ( HSCT ) recipients; they can lead to hemorrhagic cystitis, ureteral stenosis, renal dysfunction, and prolonged hospital stays. In this study, we determined transplant‐associated variables and immune parameters that can predict for the risk of BKP yV viruria. We hypothesized that BKP yV infection is a marker of poor immune recovery. Methods We analyzed all engrafted patients undergoing first allogeneic HSCT at MD Anderson Cancer Center in Houston between January 2004 and December 2012. We evaluated their immune parameters and their transplant‐associated factors. BKP yV positivity was defined as BKP yV detection in urine by polymerase chain reaction testing. Cox proportional hazards model, as well as competing risk analysis method using subdistribution hazard models with death as competing risk, were applied to assess risk of BKP yV viruria. Results We identified a total of 2477 patients with a median age of 52 years. BKP yV viruria was manifest in 25% (n=629) of the patients. The median time from transplantation to BKP yV viruria development was 42 days among the patients who had BKP yV viruria. On multivariate analysis, tumor type, acute GVHD , chronic GVHD , myeloablative conditioning regimen, cord blood as the graft source, CD 3 + , CD 4 + , CD 8 + , CD 56 + , NK counts, and low platelet count were shown to be significantly associated with BKP yV infection. These finding were further confirmed when models incorporating the competing risk of death yielded similar findings. Conclusion In this study, we report significant associations between BKP yV reactivation following allogeneic HSCT and suppressed immune variables. In addition, this study provides valuable information on the immune status of HSCT recipients as a predictor of BKP yV infections that may in turn help us formulate plans for more effective prevention and treatment of this infection.