Prospective Analysis of Hemorrhagic Cystitis and BK Viremia in Allogeneic Hematopoietic Stem Cell Transplantation

Atilla, Erden; Ateş, Can; Uslu, Atilla; Atilla, Pınar Ataca; Dolapçı, İştar; Tekelı, Alper; Topçuoğlu, Pervin

doi:10.4274/tjh.galenos.2019.2019.0296

Cited by 6 publications

(11 citation statements)

References 44 publications

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“…The incidence of hemorrhagic cystitis, in patients involved in the program of allogeneic HSCT at the Clinic for Hematology of the University Clinical Center of Serbia, was higher than the incidence reported in literature to date [7,8,9]. In their study, Atilla et al used ciprofloxacin as prophylaxis, and the incidence of hemorrhagic cystitis was 37%.…”

Section: Discussionmentioning

confidence: 91%

“…In all patients, the PCR status regarding the BK polyomavirus in the blood and urine was determined once a week, until D+100. The day when the neutrophil count was above 1x10 9 and the platelet count was above 20x10 12 was taken to be the day of engraftment. The diagnosis of hemorrhagic cystitis was established on the basis of microbiological findings and the presence of hematuria.…”

Section: Microbiological Methodsmentioning

confidence: 99%

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BK polyomavirus as the cause of hemorrhagic cystitis in patients treated with allogeneic stem cell transplantation

Stanković¹,

Đunić²

2022

Srpski medicinski časopis Lekarske komore

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Introduction: BK polyomavirus is a double-stranded DNA virus from the Polyomaviridae family. According to DNA sequences, this virus can be classified into six genotypes. In hematological patients enrolled in allogeneic hematopoietic stem cell transplantation (HSCT) programs, it can lead to hemorrhagic cystitis. Aim: The aim of this study is calculating the prevalence of BK polyomavirus PCR (polymerase chain reaction) positivity in the blood and urine of patients involved in allogeneic HSCT, determining the predictive factors for clinical presentation of BK polyomavirus-associated hemorrhagic cystitis, as well as determining its effects on overall survival (OS) of the patients. Materials and methods: This retrospective cohort study enrolled 42 patients from the Clinic of Hematology of the University Clinical Center of Serbia. The presence of the virus in blood and urine was determined by the PCR method. The survival rate of the patients in relation to hemorrhagic cystitis was calculated with the Kaplan-Meier method and comparison was performed with the log-rank test. Results: A positive PCR result in the blood was found in 97.6% of the subjects, while urine tested positive in 100% of patients. The estimated survival time in patients without hemorrhagic cystitis was 44.357 months, while the group with the clinical presentation of hemorrhagic cystitis had an estimated survival time of 17.395 months. Based on the log-rank test, we found a significant difference in survival between those groups of patients (p = 0.049). With regards to leukocyte engraftment day, patients engrafted after D+14, had a higher frequency of hemorrhagic cystitis (p = 0.037). Conclusion: BK polyomavirus-associated hemorrhagic cystitis is a common complication of treatment in patients suffering from hematological malignancies who are enrolled in an alo-HSCT program, and has a significant impact on OS..

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Section: Discussionmentioning

confidence: 91%

Section: Microbiological Methodsmentioning

confidence: 99%

BK polyomavirus as the cause of hemorrhagic cystitis in patients treated with allogeneic stem cell transplantation

Stanković¹,

Đunić²

2022

Srpski medicinski časopis Lekarske komore

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“…CMV reactivated was also an independent risk factor for HC in our study ( P = .05 in multivariate analysis). Many previous studies have also shown that CMV infection is a risk factor for HC 12–14 . Moreover, reactivation of CMV is often accompanied by the reactivation of other viruses, such as BKV 12 .…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation

Shen

Zhang

et al. 2022

Blood Science

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Hemorrhagic cystitis (HC) is a common complication of allogeneic hematopoietic stem cell transplantation (HSCT). The incidence is about 7% to 68%, and some patients have to suffer a long period of frequent, urgent, and painful urination, which brings great pain. This study aimed to analyze risk factors of HC and its effect on patient survival. We collected the medical records of 859 patients who underwent HSCT at our hospital between August 2016 and August 2020. Patients with and without HC were matched using propensity score matching at a 1:1 ratio based on sex, age, and diagnosis, and logistic regression analyses were used to identify factors associated with HC. We used Kaplan–Meier curves to analyze the survival rates of patients in the HC and non-HC groups. We also analyzed the relationship between BK viral load and the occurrence of HC using receiver operating characteristic curve (ROC) analysis. After propensity score matching, there were 131 patients each in the HC and non-HC groups. In the HC group, 89 patients (67.9%) had mild HC (stage II°) and 43 (32.1%) had severe HC (stage III–IV). The median interval between stem cell transplantation and HC development was 31 (3–244) days. Univariate analysis indicated that donor age, hematopoietic stem cell source, HLA, acute graft-versus-host disease, busulfan, anti-thymocyte globulin (ATG), total body irradiation, cytomegalovirus (CMV) (urine), and BK polyomavirus (BKV) (urine) were significantly associated with HC. ATG, CMV (urine), and BKV (urine) were independent risk factors for HC based on the multivariate analysis. The Kaplan–Meier survival analysis showed no significant difference between the HC and non-HC groups (P = .14). The 1- and 2-year survival rates in the HC group were 78.4% and 69.6%, respectively, and the corresponding rates in the non-HC group were 84.4% and 80.7%, respectively. ROC analysis indicated that a urine BKV load of 1 × 107 copies/mL was able to stratify the risk of HC. In conclusion, when the BKV load is >1 × 107, we need to be aware of the potential for the development of HC.

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“…Kwon et al 27 found that the median peak of the urine BKV load was 2.5 × 10 10 copies/mL (range: 1.4 × 10 9 ‐1.2 × 10 11 copies/mL). 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 .…”

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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Prospective Analysis of Hemorrhagic Cystitis and BK Viremia in Allogeneic Hematopoietic Stem Cell Transplantation

Cited by 6 publications

References 44 publications

BK polyomavirus as the cause of hemorrhagic cystitis in patients treated with allogeneic stem cell transplantation

BK polyomavirus as the cause of hemorrhagic cystitis in patients treated with allogeneic stem cell transplantation

Risk factors associated with hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation

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

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