Abstract: SA-PO1145
BK Virus Nephropathy After Chimeric Antigen Receptor (CAR)-T Cell Therapy for Diffuse Large B-Cell Lymphoma in a Kidney Transplant Recipient
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Dabbas, Walaa, University of Illinois Chicago, Chicago, Illinois, United States
- Dzielawa, Hannah, University of Illinois Chicago, Chicago, Illinois, United States
- De La Torre, Kathy Marie, University of Illinois Chicago, Chicago, Illinois, United States
- Galvez, Carlos, University of Illinois Chicago, Chicago, Illinois, United States
- Valdepenas, Benito, University of Illinois Chicago, Chicago, Illinois, United States
- Naik, Ruchi Harshadrai, University of Illinois Chicago, Chicago, Illinois, United States
- Tang, Ignatius Yun-Sang, University of Illinois Chicago, Chicago, Illinois, United States
Introduction
BKV nephropathy (BKVN) occurs in kidney transplant recipients (KTR) due to immunosuppression. The incidence of BK viremia/BKVN after conventional chemotherapy or CAR T-cell therapy is unclear. We report a KTR who developed BK nephropathy after CAR T-cell therapy 8 years post-transplant.
Case Description
A 26-year-old man with ESKD underwent kidney transplant 8 years ago, with basiliximab induction and maintained on tacrolimus/ and mycophenolic acid with stable renal function and undetectable BK and EBV PCRs.
He presented with right-sided abdominal pain. CT abdomen/pelvis showed enlarged right lower quadrant nodal masses. Cecal biopsy showed monomorphic PTLD consistent with DLBCL, germinal center subtype, EBV-negative. PET/CT showed extensive hypermetabolic abdominal/peritoneal disease.
Mycophenolic acid was replaced with prednisone, and he received 6 cycles of R-CHOP for advanced-stage disease. Repeat PET/CT was consistent with refractory lymphoma so he received 4 cycles of Pola-R bridging therapy; repeat PET/CT showed disease progression. He then underwent CAR T-cell therapy following lymphodepletion with fludarabine and cyclophosphamide.
Throughout the course, BKV and EBV PCRs were undetectable. 5 months after CAR T-cell therapy, despite complete lymphoma response, BKV PCR was detected at 3,200 IU/mL and increased to 506,000 IU/mL. He received 4 cycles of high dose IVIG (2 g/kg each). Kidney biopsy was done for persistent viremia and elevated donor-derived cell-free DNA (0.45%, 108 copies/mL) and showed BK nephropathy without rejection. After a cycle of IVIG, BK PCR improved to 5,120 IU/mL (Figure).
Discussion
BK viremia and BKVN may develop after CAR T-cell therapy in KTRs despite previously negative BK PCR throughout conventional chemotherapy. Careful post-CAR T monitoring for BK virus should be considered in this population.