Significance of BK Polyomavirus in Long-Term Survivors after Adult Allogeneic Stem Cell Transplantation

Abstract

Background: Allogeneic stem cell transplantation (aSCT) is a common treatment for a variety of hematological diseases. Advances in transplantation practices have led to an increasing number of long-term aSCT survivors, but data about health status and late complications are sparse. This analysis focusses on kidney function and urological complications in this population. Methods: This study is a prospective unicentric non-interventional trial. Before starting the study, we obtained the approval of the local ethics review board. Furthermore, the study was registered at WHO Clinical Trial Registry. The study protocol is available via UTN. Results: We were able to include 33 patients with a mean age of 60.5 years (SD 11.1). The median survival time following allogeneic stem cell transplantation was 9.0 years (IQR 8.5–13.0). Five patients (15.2%) had BKPyV viruria with mean 218.3 (SD 674.2) copies/mL. BKPyV viruria was significantly linked to pre-existing chronic kidney failure (p = 0.019), creatine > 100 µmol/L (p < 0.001), and cystatin c > 1.11 mg/L (p = 0.021), respectively. We were not able to identify a single risk factor for BKPyV viruria in univariate or multivariate Cox regression. Conclusions: BKPyV-associated nephropathy might be one reason for impaired kidney function in long-term survivors of aSCT.

Significance of men’s health in long-term survivors of allogeneic stem cell transplantation

“…Advances in the transplantation practices and supportive care have led to improved outcomes and an increasing number of long-term aSCT survivors. Most deaths after aSCT occur within the first 2 years as a result of relapse, acute or chronic Graft versus host disease (GvHD), infections or other acute or subacute toxicities [ 1 , 2 ]. However, patients who survive beyond these 2 years after aSCT have also an increased risk of long-term complications, which may impact on their survival and quality of life [ 2 , 3 ].…”

“…Most deaths after aSCT occur within the first 2 years as a result of relapse, acute or chronic Graft versus host disease (GvHD), infections or other acute or subacute toxicities [ 1 , 2 ]. However, patients who survive beyond these 2 years after aSCT have also an increased risk of long-term complications, which may impact on their survival and quality of life [ 2 , 3 ]. Reported long-term complications in this special patient population include chronic kidney disease, viral infections, e.g., BK polyomavirus (BKPyV) associated nephropathy (BKVAN) or even hypogonadism [ 2 , 4 – 10 ].…”

“…However, patients who survive beyond these 2 years after aSCT have also an increased risk of long-term complications, which may impact on their survival and quality of life [ 2 , 3 ]. Reported long-term complications in this special patient population include chronic kidney disease, viral infections, e.g., BK polyomavirus (BKPyV) associated nephropathy (BKVAN) or even hypogonadism [ 2 , 4 – 10 ]. Unfortunately, the knowledge about chronic kidney disease, urological complications as well as infections is very limited, especially in adult aSCT and in long-term survivors (more than 5 years after aSCT) [ 2 , 4 ].…”

“…Reported long-term complications in this special patient population include chronic kidney disease, viral infections, e.g., BK polyomavirus (BKPyV) associated nephropathy (BKVAN) or even hypogonadism [ 2 , 4 – 10 ]. Unfortunately, the knowledge about chronic kidney disease, urological complications as well as infections is very limited, especially in adult aSCT and in long-term survivors (more than 5 years after aSCT) [ 2 , 4 ]. Furthermore, data about men’s health including hypogonadism as well as male sexual function are even more sparse in this special patient population [ 10 , 11 ].…”