BK virus infection in hematopoietic stem cell transplant recipients: Frequency, risk factors, and association with postengraftment hemorrhagic cystitis

Department of Laboratory Medicine, University of Washington Seattle, Seattle, Washington, United States
Clinical Infectious Diseases (Impact Factor: 9.42). 01/2005; 39(12):1861-5. DOI: 10.1086/426140
Source: PubMed

ABSTRACT Blood samples from 132 consecutive hematopoietic stem cell transplant recipients were obtained and tested weekly for BK virus DNA by use of quantitative real-time PCR. Forty-four patients (33%) developed BK viremia at a median of 41 days (range, 9-91 days) after transplantation. Patients with hemorrhagic cystitis that occurred after platelet engraftment had higher levels of viremia than did patients without hemorrhagic cystitis (median, 9.7x10(3) vs. 0 copies/mL; P=.008) and patients with hemorrhagic cystitis that occurred before platelet engraftment (median, 9.7x10(3) vs. 0 copies/mL; P=.0006). BK viremia also was strongly associated with postengraftment hemorrhagic cystitis in a time-dependent analysis (P=.004).

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    ABSTRACT: The BK virus is a member of the polyomavirus family. When the immune system is compromised, as in patients undergoing chemotherapy after hematopoietic stem cell and solid organ transplantation, the virus is reactivated, leading to haemorrhagic cystitis. While the BK virus is one of the most common causes of morbidity and mortality in patients after allogeneic stem cell transplantation, it rarely occurs after autologous stem cell transplantation. The early diagnosis and treatment of viral cystitis may prevent significant morbidity and mortality associated with haemorrhagic cystitis caused by the BK virus. It is not entirely clear how the BK virus affects prognosis in patients undergoing allogeneic and autologous hematopoietic stem cell transplantation.
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    ABSTRACT: Hemorrhagic cystitis (HC) is a common complication after allogeneic hematopoietic SCT (allo-HSCT). Several risk factors have been suggested including BU-containing myeloablative conditioning, unrelated donors and GVHD, but these have not been consistently reported. We conducted a retrospective study including 339 allo-HSCT recipients between 2009 and 2012. Of 339 patients, 79 (23.3%) developed HC with 2-year cumulative incidence of 24.0% (95% confidence interval, 19.4-28.9). The median onset time was 45 days (range, 16-430) after allo-HSCT. Sixty-two patients (84%) out of 74 evaluated for urine BK virus PCR testing showed a positive result (mean 2.0 × 10(10) copies of DNA per mL). In univariate analysis, myeloablative conditioning, HLA-mismatched donor, CMV viremia and acute GVHD (aGVHD) grade 3-4 were significantly associated with the risk of HC. Multivariate analysis confirmed all associating factors identified in univariate analysis except for HLA-mismatched donor: myeloablative conditioning (hazard ratio (HR) 2.63, P=0.003), CMV viremia (HR 1.88, P=0.014) and aGVHD grade 3-4 (HR 1.71, P=0.029). HC did not affect OS or non-relapse mortality. Symptomatic HC is a frequent complication following allo-HSCT, with a 2-year cumulative incidence of 24.0%. Three clinical factors associated with HC were identified including myeloablative conditioning, CMV viremia and severe aGVHD.Bone Marrow Transplantation advance online publication, 11 August 2014; doi:10.1038/bmt.2014.181.
    Bone Marrow Transplantation 08/2014; DOI:10.1038/bmt.2014.181 · 3.47 Impact Factor