Journal Article

High burden of BK virus-associated hemorrhagic cystitis in patients undergoing allogeneic hematopoietic stem cell transplantation

Chidiac, C, Salles, G, Tedone, N, Ferry, T, Nicolini, F-E, Gilis, L, Labussière-Wallet, H, Thomas, X, Billaud, G, Barraco, F, Morisset, S, Sobh, M, Ducastelle-Leprêtre, S, Michallet, M, Detrait, M, Ader, F

2014

Overview

BK virus (BKV) reactivation has been increasingly associated with the occurrence of late-onset hemorrhagic cystitis (HC) after allogeneic hematopoietic SCT (allo-HSCT) resulting in morbidity and sometimes mortality. We investigated the incidence, risk factors and outcome of BKV-HC in 323 consecutive adult patients undergoing allo-HSCT over a 5-year period. BK viremia values for HC staging were evaluated, as well as the medico-economic impact of the complication. Forty-three patients developed BKV-HC. In univariate analysis, young age ( P =0.028), unrelated donor ( P =0.0178), stem cell source ( P =0.0001), HLA mismatching ( P =0.0022) and BU in conditioning regimen ( P =0.01) were associated with a higher risk of developing BKV-HC. In multivariate analysis, patients receiving cord blood units (CBUs) ( P =0.0005) and peripheral blood stem cells ( P =0.011) represented high-risk subgroups for developing BKV-HC. BK viremia was directly correlated to HC severity ( P =0.011) with a 3 to 6-log peak being likely associated with grades 3 or 4 HC. No correlation was found between BKV-HC and acute graft versus host disease or mortality rate. Patients with BKV-HC required a significantly longer duration of hospitalization ( P <0.0001), more RBC ( P =0.0003) and platelet transfusions ( P <0.0001). Over the 5-year study period, the financial cost of the complication was evaluated at €2 376 076 ($3 088 899). Strategies to prevent the occurrence of late-onset BKV-HC after allo-HSCT are urgently needed, especially in CBU and peripheral blood stem cell recipients. BK viremia correlates with the severity of the disease. Prospective studies are required to test prophylactic approaches.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 631/532/1542 / 692/699/255/2514 / 692/699/2768/1335 / 692/700/565/545/576/1955 / Adolescent / Adult / Aged / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Antiviral Agents - therapeutic use / Bacteriology / Biological and medical sciences / BK Virus / Blood / Bone marrow / Bone marrow, stem cells transplantation. Graft versus host reaction / Cell Biology / Cord blood / Cystitis / Cystitis - economics / Cystitis - epidemiology / Cystitis - virology / Cytosine - analogs & derivatives / Cytosine - therapeutic use / Economic analysis / Economic impact / Female / Graft vs Host Disease - economics / Graft vs Host Disease - epidemiology / Graft-versus-host reaction / Health Care Costs / Hematologic Neoplasms - economics / Hematologic Neoplasms - epidemiology / Hematologic Neoplasms - therapy / Hematology / Hematopoietic Stem Cell Transplantation - adverse effects / Hematopoietic Stem Cell Transplantation - economics / Hematopoietic stem cells / Hemorrhage / Hemorrhagic cystitis / Histocompatibility antigen HLA / Hospital Costs / Humans / Immunology / Impact analysis / Incidence / Infectious diseases / Internal Medicine / Life Sciences / Male / Medical sciences / Medicine / Medicine & Public Health / Microbiology and Parasitology / Middle Aged / Morbidity / Mortality / Multivariate analysis / Nephrology. Urinary tract diseases / Organophosphonates - therapeutic use / original-article / Peripheral blood / Polyomavirus Infections - drug therapy / Polyomavirus Infections - economics / Polyomavirus Infections - epidemiology / Public Health / Risk analysis / Risk Factors / Risk groups / Stem cell research / Stem cell transplantation / Stem Cells / Subgroups / Transfusions. Complications. Transfusion reactions. Cell and gene therapy / Transplantation / Transplantation, Homologous / Tumor Virus Infections - drug therapy / Tumor Virus Infections - economics / Tumor Virus Infections - epidemiology / Urinary system involvement in other diseases. Miscellaneous / Urinary tract. Prostate gland / Viral diseases / Viremia / Viremia - complications / Viremia - drug therapy / Viremia - immunology / Virology / Virus diseases / Viruses / Young Adult