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: 8.89). 01/2005; 39(12):1861-5. DOI: 10.1086/426140
Source: PubMed


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, 9.7 × 103vs. 0 copies/mL; P = .008) and patients with hemorrhagic cystitis that occurred before platelet engraftment (median, 9.7 × 103vs. 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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    • "Pediatric hemato-oncology patients are also susceptible to developing infectious HC because they are immunocompromised. BK polyomavirus, adenovirus types 7, 11, 34, and 35, cytomegalovirus (CMV), JC virus, and herpes virus have all been reported to cause HC (Erard et al. 2004). BK virus is ubiquitous and prevalent in the pediatric population . "
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    ABSTRACT: To find a relationship between clinical and sonographic appearance of hemorrhagic cystitis (HC) in pediatric hematooncology patients. Clinical and sonographic findings of 31 children (M:F = 18:13; mean age, 12.7 years) with HC in pediatric hematooncology patients were reviewed. For each patient, the onset of HC after transplantation, use of bladder-toxic agent, presence of BK viruria, and duration of disease were reviewed. Sonographic findings including bladder wall thickness (BWT), the type of bladder wall thickening (nodular vs. diffuse), occurrence of hydronephrosis or pyelonephritis were reviewed. We analyzed sonographic appearance and clinical manifestations of HC. HC occurred within 4 months after HSCT/BMT. 27 patients (87.0 %) were positive for BK viruria and 24 patients (77.4 %) took bladder-toxic agents. On sonography, nodular type bladder wall thickening was more frequent (54.8 %), and BWT was thicker in this group (p = 0.003). There was a positive correlation between the BWT on initial sonography and duration of cystitis (r 2 = 0.340). Hydronephrosis developed in 25.8 % of patients with HC, and as HC persisted longer, hydronephrosis occurred more (p = 0.004). In patients with HC after HSCT/BMT, the BWT on initial sonography correlates well with the duration of cystitis. And, longer time of HC develops the risk of hydronephrosis.
    Full-text · Article · Dec 2015 · SpringerPlus
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    • "In the case of patients undergoing haematological stem cell transplantation (HSCT), there are a wide range of drugs that are implicated in inducing HC, such as cyclophosphamide, ifosfamide, busulphan and thiotepa [1]. As the management of HSCT patients includes prolonged immunesuppression, there is also a susceptibility to develop viral related HC [3]. The consequences of HC impact on the quality of life of HSCT patients, prolonged hospitalisation, increased requirement for transfusion support, and in the most severe cases, this may be a direct cause of patient death. "
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    ABSTRACT: Haemorrhagic cystitis (HC) is a recognised complication in patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT). This study evaluates the incidence and severity of HC in patients undergoing allogeneic HSCT during hospitalisation and within the first 100 days following transplant, looking at the use of prophylaxis, management of HC, outcomes at 100 days post transplant, and to identify any correlations between development of HC and the different conditioning regimens for transplant or HC prevention methods used. Four hundred and fifty patients (412 adult and 38 paediatric) were enrolled in this prospective, multicentre, and observational study. HC was observed in 55 patients (12.2%) of which 8/38 were paediatric (21% of total paediatric sample) and 47/412 adults (11.4% of total adult sample). HC was observed primarily in the non-related HSCT group (45/55; 81.8%, p= 0.001) compared to sibling and myeloablative transplant protocols (48/55; 87.3%; p= 0.008) and with respect to reduced intensity conditioning regimens (7/55;12.7%). In 33 patients with HC (60%), BK virus was isolated in urine samples, a potential co-factor in the pathogenesis of HC. The median day of HC presentation was 23 days post HSCT infusion, with a mean duration of 20 days. The most frequent therapeutic treatments were placement of a bladder catheter (31/55; 56%) and continuous bladder irrigation (40/55; 73%). The range of variables in terms of conditioning regimens and so on, makes analysis difficult. This multi-centre national study reported similar incidence rates of HC to those in the literature. Evidence-based guidelines for prophylaxis and management are required in transplant centres. Further research is required to look at both prophylactic and therapeutic interventions, which also consider toxicity of newer conditioning regimens.
    Full-text · Article · Apr 2014 · ecancermedicalscience
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    • "While co-infection of polyomavirus and cytomegalovirus have been reported in renal transplant recipients [28,29] and after stem cell transplantation [30], the impact of recipient CMV seropositivity without evidence of CMV viremia on polyomavirus infection is unknown. However, in a study of 132 hematopoietic stem cell transplant recipients a positive recipient CMV serostatus and the underlying disease emerged as the only risk factors associated with BK viremia [31]. "
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    ABSTRACT: Polyomavirus BK nephropathy (PyVAN) remains an important cause of early graft dysfunction and graft loss in kidney transplantation. In this retrospective, single centre cohort study we studied the incidence and outcome of BK viral infection in 352 patients transplanted in 2008--2011. During follow-up viral replication was detected in 48 patients (13.6%); 22 patients (6.2%) had biopsy proven PyVAN.In multivariate logistic regression analyses risk factors for BK-viremia were lack of enrolment into randomized controlled trials (RCTs), biopsy proven acute rejections, cytomegaly virus (CMV) serostatus of both donor and recipient and previous transplantation.In patients without PyVAN reduction or switch of immunosuppression was associated with rapid viral clearance and stable graft function. In contrast, in most patients with PyVAN graft function deteriorated and 5 patients prematurely lost their allograft. Switch of immunosuppression to a low dose cyclosporine plus mTOR inhibitor based regimen in patients with PyVAN was safe, well tolerated and tended to be associated with a better short-term outcome in terms of graft function compared to reduction of existing immunosuppression alone. With the lack of licensed anti-polyoma viral drugs reduction or conversion of immunosuppression remains the mainstay of therapy in patients with PyVAN. The combination of low dose cyclosporine plus mTOR inhibition appears to be safe and warrants further investigation.
    Full-text · Article · Oct 2013 · BMC Nephrology
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