Cidofovir treatment of human polyomavirus‐associated acute haemorrhagic cystitis

Abstract

We report the case of an 18-year-old patient who received an allogeneic bone marrow transplant from an HLA-identical unrelated donor for a Ph+ acute lymphoblastic leukemia, in his third complete remission. Cyclophosphamide and busulfan were used as conditioning treatment. Acute graft-versus-host disease developed on day +9, and the response to adequate treatment (steroids) was favourable. On day +45 the patient developed an acute severe haemorhragic cystitis, and BK polyomavirus was demonstrated in urine samples using electron microscopy and polymerase chain reaction. Urinary symptoms did not improve in spite of palliative treatment, but a response was evident after 2 weeks of cidofovir treatment.

Polyoma viruria following T-cell-depleted allogeneic transplants using Campath-1H: incidence and outcome in relation to graft manipulation, donor type and conditioning

“…21 Its efficacy in the clinical setting has been reported in two case reports. 22,23 We used cidofovir in one patient for a single dose and this was associated with clinical improvement. However, a virological response in this patient and others occurred only after the reduction of immunosuppression.…”

A prospective study of BK-virus-associated haemorrhagic cystitis in paediatric patients undergoing allogeneic haematopoietic stem cell transplantation

“…25 The initial treatment of HC consisted of supportive measures (hyperhydration, forced diuresis and/or bladder irrigation). For patients with persistent bleeding, therapy with prostaglandins, GM-CSF and 1,26 cidofovir (CDV) 21,27 and hyperbaric oxygen therapy were used at the discretion of the transplant physician. 1 In patients with BK-related HC and no signs of active acute GVHD, a reduction or temporary withdrawal of immune suppression was tried.…”

Clinical Potential of the Acyclic Nucleoside Phosphonates Cidofovir, Adefovir, and Tenofovir in Treatment of DNA Virus and Retrovirus Infections

“…In a patient with BK polyomavirus-associated acute hemorrhagic cystitis who had received an allogeneic bone marrow transplant, cidofovir proved efficacious (90), but in another case of BK virus-associated hemorrhagic cystitis in an HIV-infected patient, there was apparently no response to cidofovir (17). BK virus-associated nephropathy has been increasingly recognized as an important cause of renal transplant dysfunction, and cidofovir (at a dose as low as 0.25 to 1 mg/kg) was found to reduce BK viruria to undetectable levels, accompanied by stable renal function for 6 to 26 months post-therapy.…”