Successful hyperbaric oxygen therapy for refractory BK virus‐associated hemorrhagic cystitis after cord blood transplantation

Abstract

BK virus-associated hemorrhagic cystitis (BKV-HC) is a common and major cause of morbidity in recipients of allogeneic hematopoietic stem cell transplantation. A 32-year-old woman developed severe BKV-HC on day 24 after cord blood transplantation (CBT). Despite supportive therapies - such as hyperhydration, forced diuresis, and urinary catheterization - macroscopic hematuria and bladder irritation persisted for over a month. Hyperbaric oxygen (HBO) therapy at 2.1 atmospheres for 90 min per day was started on day 64 after CBT. Macroscopic hematuria resolved within a week, and microscopic hematuria was no longer detectable within 2 weeks. Hematuria did not recur after 11 sessions of HBO therapy, and no significant side effects were observed during or after treatment. HBO therapy could thus be useful in controlling refractory BKV-HC after CBT.

Hyperbaric Oxygen Therapy of an Adolescent Stem Cell Transplantation Recipient with Hemorrhagic Cystitis and BK Virus

“…Savva-Bordalo et al reported similar findings with clinical resolution of hematuria in 94% of the 16 patients they treated with HBOT [20]. To date, there continues to be growing evidence of HBOT being an adjunctive therapy for patients with BK virus-associated HC after SCT [14,20,21,27]. Although the primary reason for using HBOT, in this case, was due to persistent HC despite standard of care therapy [20], it is also the third reported case in the United States, to the authors' knowledge, and provides added support as an option for HBOT in these cases.…”

“…Hemorrhagic cystitis is well-reported and documented in the literature as one of the frequent complications of hematopoietic SCT, and it is the result of diffuse inflammation and vascular injury of the bladder mucosa due to immunosuppression and opportunistic infections [16,18]. Late-onset HC is a dangerous and often life-threatening condition that it is frequently associated with reactivation of various viruses such as adenovirus, polyoma, and BKV [14,22]. To further assist in healing, HBOT can be used to treat damaged tissue from hypoxic injury and wound healing through stimulation of angiogenesis and fibroblast proliferation primarily in the HSCT-BKV-HC patient [14,[22][23][24][25][26].…”

“…Although typically associated with radiation damage, HC is also considered to be one of the potential adverse effects related to stem cell transplantation (SCT). It has been reported that the incidence of HC can be as high as 50% or more of SCT procedures and represents a noteworthy morbidity risk to these patients [14]. Further, the effects of HC on the bladder wall consist of not only inflammation, bleeding, irritation, and pain but also infections, scarring, stiffening of the bladder, and decreased volume capacity.…”

“…Moreover, BK virus (BKV) commonly presents as a polyomavirus latent opportunistic infection in SCT patients, a major contributing factor to the onset of HC of up to 50% or more in this population [14,20]. It is also estimated that the BK virus is present in up to 80% of the general population, expressed as opportunistic in the immunosuppressed and immunocompromised patients [14,20]. Late-onset HC is also attributed to BKV in this population of immunosuppressed, immunocompromised individuals [14,20].…”

“…It is also estimated that the BK virus is present in up to 80% of the general population, expressed as opportunistic in the immunosuppressed and immunocompromised patients [14,20]. Late-onset HC is also attributed to BKV in this population of immunosuppressed, immunocompromised individuals [14,20]. Therefore, based on recent and initial findings regarding the use of HBOT in patients undergoing SCT and their concomitant posttransplant morbidities, a consult was requested resulting in this nonusual adjunctive treatment approach [18].…”