An Association between BK Virus Replication in Bone Marrow and Cytopenia in Kidney-Transplant Recipients

Table 4

Immunosuppressive therapy given to patients with BKV replication within bone marrow.

Patient no.	Induction therapy	Acute rejection	Acute-rejection treatment	Immunosuppressive therapy regimen	Tac or SRL or CsA levels§: (ng/mL)	MPA dose: (mg/kg/d)	Steroid dose: (mg/kg/d)	Virus in bone marrow	Virus in blood
1	Anti-IL2R	Y	Steroid pulses	Belatacept-MPA-S	—	14.3	0.14	BKV	—
2	RATG	N	—	Tac-Lef-S	3 to 6	—	0.07	BKV	BKV
3	RATG	N	—	SRL-MPA-S	8 to 14	11.11	0.11	BKV-EBV	EBV
4	RATG	N	—	Tac-MPA-S	5 to 8	11	0.13	BKV	BKV
5	Anti-IL2R	Y	Steroid pulses; RATG	Tac-MPA-S	4 to 7	12.5	0.06	BKV	BKV
6*	Anti-IL2R	Y	Steroid pulses; PE; Rituximab	Tac-MPA-S	3 to 6	5.5	0.17	BKV	BKV
7	Anti-IL2R	Y	Steroid pulses; PE; Rituximab	Tac-MPA-S	5 to 8	13.2	0.16	BKV	—
8	Anti-IL2R	N	—	CsA-MPA-S	600 to 900	15.6	0.08	BKV	BKV

∗Patient 6 experienced a steroid-sensitive acute rejection, which was treated with steroid pulses. Later, he presented with relapsed membrano-proliferative glomerulonephritis, which required plasma exchanges and rituximab therapy.
§Levels correspond to trough levels for tacrolimus and sirolimus, and to the level of cyclosporine A at 2 h after intake.
Abbreviations: Anti-IL2R: anti-interleukin-2 receptors; RATG: rabbit anti-thymocyte globulins; Y: yes, N: no; PE: plasma exchange; MPA: mycophenolic acid; S: steroid; Tac: tacrolimus; Lef: leflunomide; SRL: sirolimus; CsA: cyclosporine A.