Relationship between clinical and BK virological response in patients with late hemorrhagic cystitis treated with cidofovir: a retrospective study from the European Group for Blood and Marrow Transplantation

Abstract

To investigate the relationship between clinical response and modification of BK viremia, we assessed retrospectively 32 cases of hemorrhagic cystitis (HC) after allogeneic hematopoietic SCT that were treated with i.v. cidofovir (CDV). They were 22 men (69%) and 10 women (31%) with a median age of 24 years, range 3-62. The median number of CDV doses was 3, range 1-8, and the treatment lasted for a median of 3 weeks, range 1-10. Clinical improvement of HC was observed in 27 patients (84%). In 12 of 32 episodes (37.5%), BK viremia was determined before every CDV administration and a complete clinical response was observed in 10 of 12 patients (83%), the reduction of BK viremia load being X1 log by 2 weeks after starting CDV. Nephrotoxicity related to CDV was observed in nine patients. Among 26 patients with 100-day follow-up, 4 of 4 patients who had a complete clinical response by 30 days were alive vs 16 of 22 (73%) who did not have the resolution of HC in this time frame. We conclude that in patients with HC, the response to CDV treatment is usually associated with a significant reduction of BK viremia load.

Comparison of intravenous or intravesical cidofovir in the treatment of BK polyomavirus‐associated hemorrhagic cystitis following adult allogeneic stem cell transplantation—A systematic review

“…Excluded studies from this systematic review are even more heterogeneous. For example, Cesaro et al in their publication from 2013 also included pediatric patients in the analysis . Thereof, an important question arises: Can adult and pediatric patients in the treatment of BKPyV‐HC be compared?…”

Insights into the mechanism of action of cidofovir and other acyclic nucleoside phosphonates against polyoma- and papillomaviruses and non-viral induced neoplasia

“…CDV proved also active in cases associated with productive infection of TSPyV and MCPyV in immunocompromised patients when the drug was administered topically (van der Meijden et al, 2010;van Boheemen et al, 2014;Wanat et al, 2012) or intravenously (Maximova et al, 2013). CDV has been used mostly systemic for the management of BKPyV and JCPyV related diseases, although intravesical instillation of CDV has been used to manage BKPyVassociated haemorrhagic cystitis in hematopoietic stem cell transplant recipients (Koskenvuo et al, 2013;Cesaro et al, 2013;Ganguly et al, 2010).…”

“…Although supportive care has been the standard of treatment for HC during many years, several clinical studies have demonstrated successful use of CDV for BKPyV-HC after hematopoietic stem cell transplantation not only in adults but also in children (Savona et al, 2007;Cesaro et al, 2013;Gaziev et al, 2010). Important factors in the pathogenesis of HC involve severe immune suppression together with urothelial damage due to conditioning and radiation (which creates a favourable environment for viral replication and leads to an augmentation in immunological signals and antigen presentation) and the attack of virus-infected urothelial cells by donor T cells.…”

BK Virus-Associated Hemorrhagic Cystitis in Patients wıth Allogeneic Hematopoietic Cell Transplantation: Report of Three Cases

“…11 In another study, clinical response was obtained in all adult patients treated with cidofovir (16/19, 84%); but only 9 of 19 patients (47%) were detected reduction greater than 1 log in the BK virus load in urine. 12 In a study conducted by Cesaro et al, 14 (81%) of 27 patients had a complete clearance of BK virus associated hemorrhagic cystitis after the introduction of cidofovir on the average 37 days. 13 Cidofovir treatment and the reduction of immunosuppressive treatment was started to the patient.…”