BK Polyomavirus Hemorrhagic Cystitis in Hematopoietic Cell Transplant Recipients

Abstract

Introduction: BK polyomavirus-associated hemorrhagic cystitis (BKPyV-HC) is a well-recognized infective complication of hematopoietic cell transplant (HCT) with increased organ dysfunction and mortality. This study was performed to describe the local incidence, risk factors, and outcomes of BKPyV infection. Methods: This retrospective case–control study was conducted between 2007 and 2016 from a tertiary hospital in South India. We identified HCT recipients diagnosed with BKPyV-HC and compared them with recipients over the same period who did not develop BK virus infection matched for age, sex, diagnosis, and donor type. We collected data from central electronic medical records and databases maintained in the departments of hematology and virology. Results: Over the study period, 1276 transplants were performed, of which 262 patients (20.5%) developed HC and 105 (8.2%) were BKPyV-positive. Grade 3 HC was most commonly (57.1%) seen, and the median time to develop BKPyV-HC was 35 (range 0–858) days. Survival was significantly lower in the cases (42.9% vs. 61%, P < 0.05). On univariate analysis, the protective effect of nonmyeloablative conditioning ( P = 0.04), residual disease at the time of transplant in malignant conditions ( P = 0.001), lower CD34 dose ( P = 0.006), presence of acute graft versus host disease (GVHD, P < 0.001), reactivation of cytomegalovirus infection ( P < 0.001), and presence of bacterial urinary tract infection (UTI) ( P < 0.001) were significant factors. Multivariate logistic regression confirmed the presence of acute GVHD ( P = 0.041), bacterial UTI ( P < 0.001), and residual disease ( P = 0.009) at HCT as significant risk factors for BKPyV-HC. Conclusions: Our study affirms the homogeneity of BKPyV-HC disease in low- and middle-income HCT settings with prior reports and the need for therapeutic strategies to reduce its resultant mortality.

Risk factors for BK virus‐associated hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation: A systematic review and meta‐analysis

“…Our pooled result supports their findings. Myeloablative conditioning offers more intense immunosuppression, and the use of increased‐intensity chemotherapy results in more mucosal trauma and acute inflammation 21,37 . In contrast, reduced intensity conditioning was a protective factor for BKV‐HC according to our pooled result.…”

“…Subsequently, two reviewers (Zhou and Fan) screened the title/abstract of the remaining studies; 1549 studies were excluded as they were unrelated to risk factors for BKV‐HC. The full texts of the remaining 99 studies were further reviewed; of these, 11 studies met the inclusion and exclusion criteria and were included in this meta‐analysis 15–25 . All included studies were retrospective and published between 2013 and 2022.…”

“…Recently, several studies have reported risk factors for BKV-HC, such as cord blood transplantation, myeloablative conditioning, graft-versus-host-disease, and use of cyclophosphamide and busulfan. [15][16][17][18][19][20][21][22][23][24][25] The conclusions of previous studies were disparate, which could be attributed to the fact that the patients were from different regions of the world. The risk factors for BKV-HC remain debatable.…”

“…To the best of our knowledge, the present study is the first meta‐analysis to systematically explore the potential risk factors for BKV‐HC in allo‐HCT recipients. Recently, several studies have reported risk factors for BKV‐HC, such as cord blood transplantation, myeloablative conditioning, graft‐versus‐host‐disease, and use of cyclophosphamide and busulfan 15–25 . The conclusions of previous studies were disparate, which could be attributed to the fact that the patients were from different regions of the world.…”

“…further reviewed; of these, 11 studies met the inclusion and exclusion criteria and were included in this meta-analysis. [15][16][17][18][19][20][21][22][23][24][25] All included studies were retrospective and published between 2013 and 2022.…”