scholarly journals Leflunomide Therapy For Bk Virus Associated Hemorrhagic Cystitis In Paediatric Hematopoietic Stem Cell Transplant Recipients

2018 ◽  
Vol 3 (3) ◽  
pp. S35
Author(s):  
Vyas Chintan ◽  
Padit Anjali ◽  
Sachdev Mansi ◽  
Dua Vikas
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Hemorrhagic Cystitis ◽  
Bk Virus ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Hematopoietic Stem

scholarly journals BK Virus Encephalitis in HIV-Infected Patients: Case Report and Review

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Luciana Antoniolli ◽  
Rafael Borges ◽  
Luciano Z. Goldani
Keyword(s):  
Stem Cell ◽  
Case Report ◽  
Clinical Features ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Hemorrhagic Cystitis ◽  
Bk Virus ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Hematopoietic Stem

Encephalitis and meningitis due to BKPyV are unusual and emerging condition. Only a few cases of BKPyV encephalitis have been reported in hematopoietic stem cell transplant recipients, with the majority of cases presenting with concurrent hemorrhagic cystitis and HIV-infected patients. The authors report two HIV-infected patients with the diagnosis of BKPyV encephalitis and discuss the main clinical, diagnostic, and therapeutic aspects of this infection in patients with AIDS. Physicians should be aware to recognize the main clinical features and diagnose BKPyV central nervous infection in the setting of AIDS.

Defining Treatment Paradigms for BK Virus-Induced Hemorrhagic Cystitis in the Post-Allogeneic Hematopoietic Stem Cell Transplant Setting

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4468-4468
Author(s):  
Devi D Morrison ◽  
Samith Thomas Kochuparambil ◽  
David Deremer ◽  
Ethan Speir ◽  
Kristen Sterling ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Hemorrhagic Cystitis ◽  
Bk Virus ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Cell Dose ◽  
The Mean

Abstract Abstract 4468 Introduction: BK viuria is an important and frequent infection in the post-allogeneic hematopoietic stem cell transplant (allo-HSCT) setting that results in significant morbidity and mortality. Over the years our understanding of the disease process has improved significantly but treatment algorithms remain poorly defined and developed. A variety of anti-viral therapies have been utilized in conjunction with reduced immunosuppression with modest benefits. We therefore present our institutional data and recommend a clinical practice guideline that could potentially improve the outcomes of patients with BK-virus infections. Method: Our retrospective analysis included 75 consecutive patients who underwent allo-HSCT from 2001–2011. Data was collected on patients with PCR proven BK-viuria under existing IRB approved protocols. SPSS version 13.0 was used for statistical analysis. Kaplan-Meier method was used to calculate survival outcomes. Result: 12% (9/75) of all patients developed PCR proven hemorrhagic cystitis (HC). The median age of patients at transplant was 37-years (range 28–61). 77% were male. 66% had acute myeloid or lymphoblastic leukemia and the median number of prior therapies was three. 33% had a matched unrelated donor transplant while 66% received reduced intensity conditioning regimen and 33% received anti-thymocyte globulin (ATG). The mean CD34+ cell dose infused was 4.8×106/kg and the mean CD3+ cell dose was 8.6×1011/kg. Median days to neutrophil engraftment were 11 and for platelet engraftment were 14. The median ECOG performance status was 1 (range 0–2). The median time of onset of HC from day 0 of transplant was 44-days (range 4–158) and lasted for an average of 53-days (range 7–157). 33% patients were neutropenic at the onset of HC and the mean absolute neutrophil count was 4300/ul. Most common symptoms were dysuria in 66%, bladder spasms in 44% and urinary retention in 22%. All patients had received GVHD prophylaxis with methotrexate and tacrolimus and 77% were on concurrent steroids and mycophenolate. 88% of patients had concurrent acute graft-vs.-host disease (GVHD) at the time of HC. 88% also had concurrent CMV viremia and 11% had EBV viremia at the time of HC. 44% developed BK-viremia while 55% had BK-virus induced nephropathy defined as an increase of serum creatinine >1.5. Management approach was tiered into prophylaxis, symptomatic relief and anti-viral therapy. All patients received ciprofloxacin and 88% received intravenous immunoglobulin (IVIg). No single therapy component including reduced immunosuppression, cidofovir and leflunomide was independently identified as a more efficacious option (p>0.05) but of the patients who received cidofovir, 75% had resolution of symptoms and were able to clear the BK-viuria with the median duration of treatment of 4.5 weeks. Conclusion: Our analysis supports existing data that BK-virus induced HC is the result of multifaceted host and donor interactions and the concurrent use of immune altering therapies. To address the need of reduced morbidity and improved outcomes of this commonly encountered scenario in the post allo-HSCT setting, we have developed a multi-tiered approach that includes prophylactic intervention with ciprofloxacin for patients undergoing T-cell depleting regimens; symptomatic management with continuous bladder irrigation, pyridium and oxybutynin; and antiviral therapy with cidofovir and leflunomide in select subsets of patients. This approach will provide us a tool to uniformly manage our patients with BK-viuria and HC, and continually analyze and improve outcomes in a prospective manner. Disclosures: No relevant conflicts of interest to declare.

Intravesicular Cidofovir in the Treatment of BK Virus–Associated Hemorrhagic Cystitis Following Hematopoietic Stem Cell Transplantation

2019 ◽  
Vol 54 (6) ◽  
pp. 547-553 ◽  
Author(s):  
Graham M. Tooker ◽  
Kristen A. Stafford ◽  
Jennifer Nishioka ◽  
Ashraf Z. Badros ◽  
David J. Riedel
Keyword(s):  
Stem Cell ◽  
Viral Load ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Hemorrhagic Cystitis ◽  
Bk Virus ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Bladder Irrigation

Background: BK virus hemorrhagic cystitis (BKV-HC) is a common complication following hematopoietic stem cell transplant (HSCT); optimal management remains uncertain. Supportive care (bladder irrigation and blood transfusions) and intravenous and intravesicular cidofovir have all been used with varying success. Objective: The purpose of this study was to determine the safety and effectiveness of intravesicular cidofovir for BKV-HC following HSCT. Methods: A retrospective analysis of all HSCT patients with BKV-HC prescribed intravesicular cidofovir from 2012 to 2017. Results: 33 patients were treated for BKV-HC. The median age was 50 years (range 23-73), and 18 (55%) were male. The median HC symptom severity was 2, with a median BK urine viral load pretreatment of 100,000,000 IU/mL. Patients received a median of 2 intravesicular treatments (range 1-7) at a dosage of 5 mg/kg per instillation. In all, 19 (59%) patients demonstrated complete clinical resolution of symptoms; 9 (28%) had a partial response; and 4 (13%) had no change in symptoms. Patients with a high pretreatment BK viral load (>100 million) and high HC grade (2-4) had a lower frequency of complete remission. The main side effect of intravesicular instillation was severe bladder spasms in 4 patients (12%). Conclusion and Relevance: This is the largest study of intravesicular cidofovir treatment of BKV HC reported to date; 88% of patients with BVK-HC achieved clinical improvement of symptoms with minimal side effects. Clinical trials of intravesicular cidofovir could provide further evidence for this treatment for BKV-HC.

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