Treatment of BK virus-associated hemorrhagic cystitis with low-dose intravenous cidofovir in patients undergoing allogeneic hematopoietic cell transplantation.
10.3904/kjim.2015.30.2.212
- Author:
Seung Shin LEE
1
;
Jae Sook AHN
;
Sung Hoon JUNG
;
Seo Yeon AHN
;
Jae Yong KIM
;
Hee Chang JANG
;
Seung Ji KANG
;
Mi Ok JANG
;
Deok Hwan YANG
;
Yeo Kyeoung KIM
;
Je Jung LEE
;
Hyeoung Joon KIM
Author Information
1. Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea. f0115@chonnam.ac.kr
- Publication Type:Original Article
- Keywords:
Cidofovir;
Hemorrhagic cystitis;
BK virus
- MeSH:
Administration, Intravenous;
Adult;
Antiviral Agents/*administration & dosage/adverse effects;
BK Virus/*drug effects/immunology;
Cystitis/diagnosis/*drug therapy/immunology/virology;
Cytosine/administration & dosage/adverse effects/*analogs & derivatives;
Drug Administration Schedule;
Female;
Hematopoietic Stem Cell Transplantation/*adverse effects;
Humans;
Immunocompromised Host;
Male;
Organophosphonates/*administration & dosage/adverse effects;
Polyomavirus Infections/diagnosis/*drug therapy/immunology/virology;
Retrospective Studies;
Time Factors;
Transplantation, Homologous;
Treatment Outcome;
Tumor Virus Infections/diagnosis/*drug therapy/immunology/virology;
Viral Load
- From:The Korean Journal of Internal Medicine
2015;30(2):212-218
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: BK virus (BKV) has been associated with late-onset hemorrhagic cystitis (HC) in recipients of hematopoietic stem cell transplantation (HSCT). Cidofovir has been used at higher doses (3 to 5 mg/kg/wk) with probenecid prophylaxis; however, cidofovir may result in nephrotoxicity or cytopenia at high doses. METHODS: Allogeneic HSCT recipients with BKV-associated HC are treated with 1 mg/kg intravenous cidofovir weekly at our institution. A microbiological response was defined as at least a one log reduction in urinary BKV viral load, and a clinical response was defined as improvement in symptoms and stability or reduction in cystitis grade. RESULTS: Eight patients received a median of 4 weekly (range, 2 to 11) doses of cidofovir. HC occurred a median 69 days (range, 16 to 311) after allogeneic HSCT. A clinical response was detected in 7/8 patients (86%), and 4/5 (80%) had a measurable microbiological response. One patient died of uncontrolled graft-versus-host disease; therefore, we could not measure the clinical response to HC treatment. One microbiological non-responder had a stable BKV viral load with clinical improvement. Only three patients showed transient grade 2 serum creatinine toxicities, which resolved after completion of concomitant calcineurin inhibitor treatment. CONCLUSIONS: Weekly intravenous low-dose cidofovir without probenecid appears to be a safe and effective treatment option for patients with BKV-associated HC.
