The strategy for progressive multifocal leukoencephalopathy (PML) in solid organ transplant recipients primarily focuses on reducing immunosuppressive therapy. However, this approach offers limited efficacy and carries a high risk of graft loss. Here, we present the case of a 64-year-old male kidney transplant recipient with a high degree of immunosuppression who developed PML in October 2022. Despite the standard reduction of immunosuppressive therapy, the patient’s condition continued to deteriorate, as evidenced by worsening neurological symptoms and increasing JC virus (JCV) DNA levels in cerebrospinal fluid. This prompted the innovative use of BKPyV-virus–specific T cell (BKPyV-VST) therapy, given the genetic similarities between BK and JCVs. Infusion of third-party donor BKPyV-VST resulted in clinical stabilization, a significant reduction in JCV-DNA levels, and the emergence of a JCV-specific T cell response, as observed in enzyme-linked immunospot assays and TCRβ sequencing. This represents the first case report of successful third-party BKPyV-VST therapy in a kidney recipient presenting PML, without graft-versus-host disease or graft dysfunction.

中文翻译：

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BK 病毒特异性 T 细胞疗法成功治疗患有进行性多灶性白质脑病的肾移植受者


实体器官移植受者进行性多灶性白质脑病 (PML) 的治疗策略主要侧重于减少免疫抑制治疗。然而，这种方法的疗效有限，并且移植物丢失的风险很高。在此，我们介绍一名患有高度免疫抑制的 64 岁男性肾移植受者的病例，他于 2022 年 10 月患上 PML。尽管免疫抑制治疗标准减少，但患者的病情持续恶化，神经功能恶化就证明了这一点。症状以及脑脊液中 JC 病毒 (JCV) DNA 水平增加。鉴于 BK 和 JCV 之间的遗传相似性，这促使 BKPyV 病毒特异性 T 细胞 (BKPyV-VST) 疗法的创新使用。正如酶联免疫斑点测定和 TCRβ 测序中所观察到的，第三方供体 BKPyV-VST 的输注导致临床稳定、JCV-DNA 水平显着降低以及 JCV 特异性 T 细胞反应的出现。这是第一个针对出现 PML 的肾受者成功进行第三方 BKPyV-VST 治疗的病例报告，且没有移植物抗宿主病或移植物功能障碍。