Abstract: SA-PO849
Clinical Course of a Kidney Transplant Recipient With BK Polyomavirus Treated With Posoleucel (PSL) Multivirus-Specific T-Cells
Session Information
- Transplantation: Clinical - Case Reports
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Taiwo, Adetokunbo A., Stanford University, Stanford, California, United States
- Busque, Stephan, Stanford University, Stanford, California, United States
- Cardarelli, Francesca, AlloVir, Waltham, Massachusetts, United States
- Ahearn, Patrick, Stanford University, Stanford, California, United States
Introduction
Treatment of BK viremia and nephropathy primarily involves reducing maintenance immunosuppression. Adjunct therapies such as cidofovir, IVIG, and leflunomide produce mixed results. We present the clinical course of a kidney transplant (KT) recipient with BK polyomavirus treated with posoleucel, a novel therapy using multivirus specific T-cells.
Case Description
A 67-year-old man with a history of AL amyloidosis post orthotopic heart transplant developed end stage kidney disease and underwent a living related KT. He received thymoglobulin induction and maintenance immunosuppression with tacrolimus, mycophenolate, and prednisone. His baseline creatinine settled around 1.4 mg/dL. Six months later, he was diagnosed with EBV+ post-transplant lymphoproliferative disease and was treated with rituximab. PET scan showed resolution. Soon after, his creatinine rose to 1.8 -2 mg/dL and a kidney biopsy showed BK polyoma virus nephropathy. Serum BK PCR at diagnosis was 3.5 million copies/mL. Mycophenolate was discontinued, tacrolimus was switched to sirolimus, and he was started on cidofovir q 2 weeks with rise in serum BK to >10 million copies/mL. Cidofovir was discontinued when his kidney function worsened. IVIG was started but was complicated by hemolytic anemia. FDA approved posoleucel for compassionate use. He received 4x10^7 PSL cells weekly for 3 doses then every other week for 3 doses. Table 1 summarizes his BK viral load and creatinine.
Discussion
PSL treatment was well tolerated with no adverse events. PSL is the only intervention associated with a significant decline of BK viremia in this patient with BK nephritis, with a ½ log decline in BK viral loads during the treatment period and further ½ log decline over follow-up. A phase 2 trial has completed enrollment.
BK viral load and creatinine
| Treatment/Follow Up | BK Viral Load (IU/mL) | Creatinine (mg/dL) |
| Treatment 1 | 2,530,654 | 3.35 |
| Treatment 2 | 2,607,078 | 3.0 |
| Treatment 3 | 1,583,579 | 3.45 |
| Treatment 4 | 1,920,140 | 4.06 |
| Treatment 5 | 1,164,649 | 3.39 |
| Treatment 6 | 1,157,669 | 3.32 |
| Follow-up 1 | 351,000 | 3.60 |
| Follow-up 2 | 346,000 | 3.63 |
| Follow-up 3 | 235,000 | 3.86 |