BKV Related Hemorrhagic Cystitis—An Insight into Risk Factors and Later Complications—An Analysis on Behalf of Polish Adult Leukemia Group

Abstract

BK virus reactivation increases the likelihood of hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplant (HCT). In this study, we aimed to identify predictive and risk factors associated with the increased occurrence of this condition following HCT. On a group of 124 patients aged ≤71 years old (median 40 years) who underwent HCT, we analyzed sex, age, time from diagnosis to transplantation, type of conditioning, donor’s relationship, age, and sex, the impact of immunosuppression with different drugs, and acute and chronic GVHD, BK viremia and viruria as potential factors increasing the risk of BK-related HC after HCT. HC occurred among 24 patients (24/124; 29.2%). A significant correlation was observed between HC incidences after HCT, BK viremia and viruria, and acute GVHD occurrence. Furthermore, the level of BKV DNA in serum at day +21 (>0.75 × 103) significantly impacted the patients’ survival time. According to our results, the likelihood ratio of BKV-DNA on day +21 in serum is 6.25, indicating that this diagnostic test has the potential to be utilized in a clinical setting. These findings may be used as a voice in the discussion on implementing an optimal preemptive treatment in BKV reactivation after allogeneic HCT.

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

“…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.…”

Incidência e farmacoterapia da cistite hemorrágica em pacientes submetidos a transplante de medula óssea: uma revisão de literatura

“…Cesaro et al (2018) relatou uma resposta de 83% em um estudo com 35 pacientes, assim como os locais de sangramento são cauterizados e colocados cola de fibrina nas partes lesadas da mucosa, através de intervenções endoscópicas, porém complicações possíveis são a obstrução dos ereteres. A cistectomia é referida como sendo o último recurso para os casos de cistite hemorrágica refratária, sendo feita a nível parcial para a preservação da uretra e colo vesical, dando possibilidade a uma capaz reconstrução cirúrgica futura (Dybko et al, 2022).…”