High incidence of adeno- and polyomavirus-induced hemorrhagic cystitis in bone marrow allotransplantation for hematological malignancy following T cell depletion and cyclosporine

Abstract

Nine of 56 (20% actuarial) patients receiving a T celldepleted, HLA-identical sibling BMT for hematological malignancy developed hemorrhagic cystitis (HC) 15-368 days post BMT. Hematuria was severe and prolonged (median duration 18 days). In eight patients (89%), a viral etiology was confirmed (four adenovirus, four polyomavirus). HC was associated with significant morbidity, with all patients requiring continuous bladder irrigation and transfusion support for blood loss and thrombocytopenia. HC occurring before day 100 was significantly associated with a reduction in longterm survival: 1/7 (14.3%) patients developing HC before day 100 became long-term survivors vs 21/49 (42.8%) without HC by day 100 (P = 0.034). In univariate analysis, HC was associated with a diagnosis of multiple myeloma (P = 0.02). There was a trend towards a higher incidence of HC in patients reactivating cytomegalovirus (CMV) compared with those remaining CMV negative (18.4 vs 5.5% respectively, P = 0.17). HC was not associated with graft-versus-host disease, or with the transplant dose of CD34 + progenitors or CD3 + cells, patient age or sex. Life-threatening, viral-induced HC and the unusually high incidence of adenovirus-induced HC may have been caused by immune deficiency associated with T cell depletion in this series.

Clinicopathological features and risk factors of clinically overt haemorrhagic cystitis complicating bone marrow transplantation

“…These included reactivation of the polyoma BK virus (BKV) and adenovirus (ADV) in the urothelium, older age at transplantation, allogeneic BMT and graft-versus-host disease. [8][9][10][11] However, most of these risks have not been observed consistently.…”

Oral ribavirin for severe adenovirus infection after allogeneic marrow transplantation

“…1,2 It is especially a problem after HSCT from unrelated donors because of more profound immunosuppression and more severe. 3,4 AD-HC is sometimes accompanied by pneumonia, renal infection and viremia resulting in death. 2 Intravenous ribavirin has been reported to be useful in AD-HC.…”

A Rare Case of Hemorrhagic Cystitis in Allogeneic Hematopoietic Stem Cell Transplant Patient

“…However, like our case, there are reports when patients have acquired adenovirus infection after 100 days post-BMT [7]. Regarding the associated risk factors involved in acquiring adenovirus infections are type of transplant (allogeneic vs autologous), history of aGVHD, use of immunosuppressive drugs, use of conditioning regimen containing cyclophosphamide, fludarabine or TBI, younger age group, asymptomatic viremia, unrelated donor, adenovirus antibody status of donor, T cell depletion of stem cell harvest [6,[8][9][10][11].…”