Relationship of BK Polyoma Virus (BKV) in the Urine with Hemorrhagic Cystitis and Renal Function in Recipients of T Cell–Depleted Peripheral Blood and Cord Blood Stem Cell Transplantations

Abstract

Hematopoietic stem cell transplant (HSCT) recipients are at significant risk for BKV reactivation, hemorrhagic cystitis (HC) and renal dysfunction. We prospectively monitored 98 HSCT by serial BKV PCR in the urine through Day (D) +100 to analyze the relationship between BKV viruria and HC, serum creatinine (Cr) and creatinine clearance (CrCl) through D +180 or death. Patients, median age 52 years, range 20-73, received T-cell depleted (50%) or cord blood allografts (21%). Median pre-HSCT BKV IgG titers were 1:10,240. Incremental increase in BKV IgG titers correlated with developing BKV viruria ≥ 107 copies/mL. By D +100, 53 (54%) patients had BKV viruria. BKV viral load in the urine increased at engraftment and persisted throughout D +100. HC developed in 10 patients (10%); 7/10 with BKV viruria. In competing risk analyses, BKV viruria ≥ 107 copies/mL, older age, CMV reactivation and foscarnet use were risk factors for HC. Cr and CrCl at 2, 3 and 6 months post-HSCT were similar between patients with and without BKV viruria.

Antibodies to BK virus in children prior to allogeneic hematopoietic cell transplant

“…Finally, Lee et al measured BKV antibodies in 98 adults undergoing HCT and reported that increasing titers were associated with viruria. Using the same assay as our analysis and similar to our findings, all 98 subjects (100%) had a detectable BKV IgG of >1:640 [19]. …”

Dynamics of BKPyV reactivation and risk of hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation

“…Several risk factors alone or in association with BKPyV have been reported to contribute to the development of HC, including GVHD, chemotherapeutics and supportive medications, and other bacterial or viral infections . In the present study, patients affected by HC showed a higher incidence of CMV reactivations (>1000 IU/mL), which has been previously correlated with BKPyV‐associated HC .…”

“…Fittingly, patients detected to be BKPyV positive in urine only did not develop clinical relevant HC. 15,30,[32][33][34][35][36] In the present study, patients affected by HC showed a higher incidence of CMV reactivations (>1000 IU/mL), which has been previously correlated with BKPyV-associated HC. 15 In line with the more protracted course of higher-grade HC (above) in conjunction with lymphocyte recovery and GVHD, patients with HC of grade II/III developed significantly more often GVHD after day+100 than those with low-grade HC.…”

Choreito Formula for BK Virus–associated Hemorrhagic Cystitis after Allogeneic Hematopoietic Stem Cell Transplantation

“…Hemorrhagic cystitis (HC) is a severe complication in patients undergoing hematopoietic stem cell transplantation (HSCT), resulting in significant morbidity, such as nephropathy and renal failure, prolonged hospitalization, and prolonged blood transfusion requirement [1,2]. Effects on mortality have also been reported in children undergoing HSCT [3].…”