Choreito Formula for BK Virus–associated Hemorrhagic Cystitis after Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

Therapy for BK virus (BKV)-associated hemorrhagic cystitis (BKV-HC) is limited after hematopoietic stem cell transplantation (HSCT). We examined whether choreito, a formula from Japanese traditional Kampo medicine, is effective for treating BKV-HC. Among children who underwent allogeneic HSCT between October 2006 and March 2014, 14 were diagnosed with BKV-HC (median, 36 days; range, 14 to 330 days) after HSCT, and 6 consecutive children received pharmaceutical-grade choreito extract granules. The hematuria grade before treatment was significantly higher in the choreito group than in the nonchoreito group (P = .018). The duration from therapy to complete resolution was significantly shorter in the choreito group (median, 9 days; range, 4 to 17 days) than in the nonchoreito group (median, 17 days; range, 15 to 66 days; P = .037). In 11 children with macroscopic hematuria, the duration from treatment to resolution of macroscopic hematuria was significantly shorter in the choreito group than in the nonchoreito group (median, 2 days versus 11 days; P = .0043). The BKV load in urine was significantly decreased 1 month after choreito administration. No adverse effects related to choreito administration were observed. Choreito may be a safe and considerably promising therapy for the hemostasis of BKV-HC after HSCT.

Neutropenia and renal dysfunction due to intravesical cidofovir for virus‐associated hemorrhagic cystitis after kidney and allogenic hematopoietic stem cell transplantations

“…First, drug‐induced neutropenia was suspected, so all the newly started drugs were discontinued. Choreito had no known adverse effects on the condition . Ciprofloxacin may cause myelosuppression (eg, agranulocytosis and thrombocytopenia), kidney disease (acute kidney injury and interstitial nephritis), and rhabdomyolysis at low frequencies.…”

Kampo patterns and radiology in children receiving choreito for hemorrhagic cystitis after hematopoietic stem cell transplantation

“…Their medical records were retrospectively analyzed. Six children (unique patient number (UPN) 9–14) had been included in a previous study . I.v.…”

“…Late‐onset HC in patients receiving HSCT is associated with viral infections, including those caused by the human polyomavirus BK (BKV), polyomavirus JC, adenovirus (AdV), and cytomegalovirus (CMV) . BKV is the most frequent cause and affects 5.3–21.2% of children undergoing HSCT . AdV is another major cause of late‐onset HC and affects 16% of children, according to a prospective testing cohort , and AdV may be a more common cause of HC in Japan .…”

“…A recent study showed that choreito ameliorated severe HC in a child with refractory acute lymphoblastic leukemia . Moreover, choreito significantly reduced macrohematuria and the overall disease course of BKV‐HC following HSCT without causing severe adverse effects . Given that no established therapy is currently available for HC in patients undergoing HSCT, choreito may be used as a first‐line treatment.…”

Kampo Medicines for Infectious Diseases

“…BK virus-associated hemorrhagic cystitis (BKV-HC) is a common problem arising occasionally after hematopoietic stem cell transplantation. A group examined the efficacy of choreito for treating BKV-HC in children who underwent allogeneic hematopoietic stem cell transplantation (Kawashima et al, 2015). The duration until complete resolution of hematuria was significantly shorter in the choreito-treated group (median 9 days, range 4-17 days) compared to the nonchoreito group (median 17 days, range 15-66 days; p = .037).…”