BK Virus-Associated Hemorrhagic Cystitis After Allogeneic Hematopoietic Stem Cell Transplantation in the Pediatric Population

Pérez-Huertas, Pablo; Cueto-Sola, Margarita; Escobar-Cava, Paloma; Fernández-Navarro, J.M.; Borrell-García, Carmela; Albert-Mari, Asuncion; López-Briz, Eduardo; Poveda‐Andrés, José Luis

doi:10.1177/1043454216631952

Cited by 13 publications

(4 citation statements)

References 35 publications

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“…They declared acute GVHD as a risk factor for BKV infection. The rate of HC was 6.5% in allogeneic HSCT patients and it is close to 9% rate of Kwon et al (15) and 8.9% rate of Lee et al (17), and similar with 6% rate of Mori et al (18), but lower than the other studies (7,10,11,19,20). According to our results, HC occurred median 56 days after HSCT and it is close to result of Lee et al (18, 69 days).…”

Section: Discussionsupporting

confidence: 88%

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BK Virus Infections in Pediatric Patients with Hematopoietic Stem Cell Transplantation

Kaya

Bayram

Öztürk

et al. 2020

Düzce Tıp Fakültesi Dergisi

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Aim: BK virus (BKV)-associated hemorrhagic cystitis (HC) is a common complication in patients after hematopoietic stem cell transplantation (HSCT). The aim of this study was to investigate the incidence of BKV infection in pediatric patients receiving HSCT. Material and Methods: Total of 51 patients aged between 16 months and 16 years old and followed up between October 2015 and September 2017 were included in the study. The patients were monitored by quantitative real-time polymerase chain reaction (Anatolia Geneworks, Turkey) test for the detection of BKV DNA in urine and blood. Results: Of patients, 46 received allogeneic HSCT and 5 autologous HSCT. BKV DNA positivity was detected in urine and/or blood of total 27 (52.9%) patients in whom 26 (56.5%) of 46 patients with allogeneic transplantation, and 1 (20.0%) of 5 patients with autologous transplantation. BKV viral load in urine >10 7 copies/ml required for preemptive treatment was detected in 12 (26.1%) of 46 patients received allogeneic HSCT. The development of HC was prevented in 9 (75.0%) of the 12 patients given preemptive treatment, while 3 (25.0%) cases developed HC and cured by treatment. BKV viruria was detected >10 9 copies/ml in two weeks before the onset of HC and was accepted as a prognostic indicator for predictive diagnosis of HC. BKV viremia was found >10 4 copies/ml in 1 patient within two weeks before the onset of cystitis. Conclusion:Screening for BKV infection, especially BKV viruria in HSCT patients, is recommended for the predictive diagnosis of HC in patients at high risk.

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Section: Discussionsupporting

confidence: 88%

“…According to our results, HC occurred median 56 days after HSCT and it is close to result of Lee et al (18, 69 days). But the many other studies reported that HC developed in a shorter time (12,14,15,(19)(20)(21).…”

Section: Discussionmentioning

confidence: 94%

BK Virus Infections in Pediatric Patients with Hematopoietic Stem Cell Transplantation

Kaya

Bayram

Öztürk

et al. 2020

Düzce Tıp Fakültesi Dergisi

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“…Atilla et al 28 investigated the relationship between BKV viremia and HC in allogeneic HSCT recipients; they claimed that the presence of BKV viremia significantly increased the risk of developing HC, and more severe HC developed in patients with a higher viral load. HC is seen in 2‐66% of patients undergoing HSCT, depending on the underlying disease, HSCT type, and the age of the patient 10‐12,29 . The frequency of HC development was reported as 20.7% by Perez Huertez et al, 29 9% by Kwon et al, 27 and 18.8% by Cesare et al 11 Hayden et al 30 claimed that the negative predictive value is higher than the positive predictive value when BKV DNA is not detected even if a high viral load is associated with cystitis.…”

Section: Discussionmentioning

confidence: 99%

Incidence of BKV in the urine and blood samples of pediatric patients undergoing HSCT

Yazısız

Uygun

Çolak

et al. 2020

Pediatric Transplantation

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The aims were to investigate the incidence of BKV infection and the presence of HC in pediatric patients undergoing HSCT. Twenty‐four children patients (M/F: 17/7) undergoing HSCT in a single center over a period of 1 year were included in the study. The presence of BKV DNA was determined by quantitative real‐time PCR in plasma and urine samples at the following times: before transplantation, twice a week until engraftment time, and weekly for + 100 days. The mean age of the patients was 7.79 ± 5.03 years, the mean follow‐up time was 95.6 ± 25.9 days, and the average number of samples per patient was 15.8 ± 3.2. BKV DNA was detected in at least one urine sample in 91.6% (n: 22) and at least one plasma sample in 75% (n:18) of the patients. The median time to the first BKV DNA positivity in urine and plasma samples was 11 (range: 1‐80) and 32 days (range: 2‐79), respectively. The median value of BKV DNA copies in urine and plasma were 1.7 × 106 (range: 2.8 × 101‐1.2 × 1014) and 1.9 × 103 copies/mL (range: 3‐2.1 × 106), respectively. Thirteen patients (54.2%) had hematuria with BKV viruria; 8 (33.3%) patients had viremia. The median value of the BKV DNA copies in urine and plasma was 4.4 × 107 (range: 65‐1 × 1011) and 2.9 × 103 (range: 7‐7.8 × 104) copies/mL in these patients. Two (15.4%) of the 13 patients with BKV viruria and hematuria were diagnosed with BKV‐related HC. BKV DNA viral load monitoring of urine and plasma in pediatric HSCT patients with a high risk for viral infections is valuable for understanding the development of BKV–related HC.

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“…The response rate observed across retrospective case series varies from 60% to 86%. 40,44,45 Renal dysfunction is the main adverse effect observed with intravenous cidofovir, with reported incidences of up to 50%. 44 Grades 3 and 4 BKV-related HC warrant treatment with cidofovir till clinical response or a maximum of 4 weeks.…”

Section: Treatmentmentioning

confidence: 99%

Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients

Jandial

Mishra

Sandal

et al. 2021

Therapeutic Advances in Infection

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BK virus (BKV)-related haemorrhagic cystitis (HC) is an important cause of morbidity following allogeneic haematopoietic stem cell transplantation (HSCT). The various risk factors include high-level BKV viruria and/or viremia, myeloablative conditioning, acute graft versus host disease (GVHD), cytomegalovirus viremia, and unrelated or HLA-mismatched donor. The presence of high plasma BK viral load and cytopenias have been implicated as important predictors for protracted disease course. These patients frequently require hospitalisation which may extend for several weeks. Supportive measures in the form of analgesics, intravenous hydration, bladder irrigation, and transfusion support remain the mainstay of management. Various drugs have been used with limited success in this setting. These include antiviral drugs, fluoroquinolones, leflunomide, growth factors, clotting factors, estrogens, and prostaglandins. The role of adoptive cellular immunotherapy has also been explored but lacks clinical validation. The strategies aimed at expediting urothelial repair like hyperbaric oxygen therapy (HBOT), intravesical fibrin glue and platelet-rich plasma (PRP) are emerging. Some patients with severe disease do require surgical intervention to relieve urinary obstruction. The frequent co-occurrence of acute GVHD and CMV disease further complicates the management in such patients. There is an unmet need for effective and evidence-based options for the prevention and management of this disease. Due to lack of robust data supported by randomised trials, the acceptability of the available guidelines to simplify the treatment is expected to be low. Despite the availability of various treatment options, the management of BKV-related HC in day-to-day practice continues to be a challenge. The aim of this article is to put forward an up-to-date review of the preventive and therapeutic strategies for BKV-related HC.

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BK Virus-Associated Hemorrhagic Cystitis After Allogeneic Hematopoietic Stem Cell Transplantation in the Pediatric Population

Abstract: We conclude that HC-BKV is a frequent complication after allo-HSCT. CDV therapy can be effective but controlled clinical trials are needed.

Cited by 13 publications

References 35 publications

BK Virus Infections in Pediatric Patients with Hematopoietic Stem Cell Transplantation

BK Virus Infections in Pediatric Patients with Hematopoietic Stem Cell Transplantation

Incidence of BKV in the urine and blood samples of pediatric patients undergoing HSCT

Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients

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