Neutropenia was observed else in all patients who had BKV replication within the bone marrow (Table 3). Microscopic analyses of the bone marrow revealed hypocellularity, which mainly affected the myelopoietic line. Granulocyte selleck chemicals Ivacaftor maturation was blocked in all patients. In addition, polymorph lymphocyte proliferation was observed in one patient, and one patient had features of hemophagocytic syndrome. Anemia can be in part attributed to impaired kidney function (Table 3). 3.3.2. Immunosuppressive Therapy Given to Recipients with BKV Replication within Bone Marrow All patients received an induction therapy of polyclonal antibodies (n = 3) or anti-interleukin-2 receptor (IL2R) blockers (n = 5) (Table 4).

Four patients had experienced an acute-rejection episode before the hematological disorder: two had steroid-sensitive acute rejection, which was treated with steroid pulses (Patients 1 and 6), one patient had a combined cellular and humoral rejection, which required steroid pulses, plasma exchanges, and rituximab (Patient 7), and one patient, who had received anti-IL2R blockers as an induction therapy, experienced steroid-resistant acute rejection, which was treated with steroid pulses and polyclonal antibodies (Patient 5). One of the two patients that experienced steroid-sensitive acute rejection presented later with relapsed membranoproliferative glomerulonephritis, which was treated with plasma exchange and rituximab (Patient 6).

Hence, overall, four patients received polyclonal antibodies and two patients received rituximab therapy.

At the time of bone-marrow aspiration, six patients were receiving calcineurin-inhibitor- (CNI-) based immunosuppression, one patient was receiving sirolimus, and one was receiving belatacept. All patients were also receiving mycophenolic acid (MPA), except for one, who received leflunomide for PVAN. All patients were given steroids. 3.3.3. Concomitant Viral Replication Seven patients had isolated BKV replication within the bone marrow. The median BKV viral load in bone Entinostat marrow was 3.02 (range: 2.74�C3.24) log10 copies/mL. Five of these seven patients had concomitant BKV replication in the blood (3.2 �� 0.96 log10 copies/mL) whereas the other two had no BKV replication in peripheral blood.

An eighth patient had concomitant BKV (3.01 log10 copies/mL) and EBV replication in the bone marrow and isolated EBV replication in the blood. Hence, overall, three patients had detectable BKV replication in the bone marrow (2.94, 3.01, and 3.24 log10 copies/mL) but BKV AV-951 replication was not detected in the blood and in the urine that were assessed twice at one week interval after bone marrow aspiration.