Successful ribavirin therapy for severe adenovirus hemorrhagic cystitis after allogeneic marrow transplant from close HLA donors rather than distant donors

Abstract

Summary:Intravenous ribavirin was given to nine patients who had developed severe adenovirus-induced hemorrhagic cystitis (AD-HC) which was resistant to conventional therapy or where there was involvement of other organs after allogeneic BMT. Three patients recovered completely from AD-HC, two of whom had been resistant to vidarabine. All three had received sibling BMTs (2 HLA matched, 1 HLA mismatched). Five patients who received BMTs from related (2 HLA mismatched) or unrelated (1 HLA matched, 2 HLA mismatched) showed an improvement in symptoms but had recurrent AD-HC after discontinuation of ribavirin. Improvement in clinical symptoms and termination of virus excretion were well correlated. The last patient who received a mismatched unrelated BMT died during ribavirin therapy. Ribavirin was notably more effective among patients receiving BMTs from siblings in contrast to patients receiving BMTs from alternative donors (Ͻ0.05). One patient experienced severe pancytopenia during the second treatment with ribavirin after HC recurrence and recovered after ceasing ribavirin. Thus, ribavirin seems to be very effective for severe AD-HC for some recipients who receive transplants from a genetically close donor. Bone Marrow Transplantation (2000) 25, 545-548.

Selective embolization of the internal iliac arteries for the treatment of severe hemorrhagic cystitis following hematopoietic SCT

“…2,13 Encouraging results with antiviral agents have been published; however, there is no evident proof in a large number of patients and mainly improve clinical symptoms. [14][15][16][17] The use of formalin, alum, prostaglandin E1, estrogens, FVIIa, factor XIII, hyperbaric oxygen treatment, intravesicular sodium hyaluronate, recombinant human epidermal growth factor or recombinant human GM-CSF has been described, but their efficacy remains controversial. [18][19][20][21][22][23][24][25][26][27] Severe HC may also require surgical treatment with cystoscopy and cauterization, and even cystectomy when previous methods have failed, 28 but it is limited by the disadvantage of operation.…”

Oral ribavirin for severe adenovirus infection after allogeneic marrow transplantation

“…1,2 It is especially a problem after HSCT from unrelated donors because of more profound immunosuppression and more severe. 3,4 AD-HC is sometimes accompanied by pneumonia, renal infection and viremia resulting in death. 2 Intravenous ribavirin has been reported to be useful in AD-HC.…”

“…2 Intravenous ribavirin has been reported to be useful in AD-HC. [4][5][6] Oral ribavirin has been used for hepatitis C, but its role in adenovirus infections is unclear.…”

“…However, the efficacies of ribavirin remain controversial. [4][5][6]10 Thus, more studies are needed to determine if this antiviral works for AD-HC. …”

A Rare Case of Hemorrhagic Cystitis in Allogeneic Hematopoietic Stem Cell Transplant Patient

“…Amongst these, ribavirin (nucleoside analogue) is found to be the next most efficient drug [15]. English literature review shows variable results of treatment with ribavirin in various studies [3,[16][17][18]. The majority of the published literature reports intravenous use of ribavirin as therapy for adenoviral infections.…”