Urological Complications and BK Virus-Associated Diseases Under Allogenic Stem Cell Transplantation

Abstract

Every year 50,000 patients receive a stem cell transplantation worldwide, but there is lack of data pertaining to urological complications. Methods: We performed a retrospective analysis of all adult patients undergoing their first allogenic stem cell transplantation from January 2011 to June 2013 in our institution. Statistical tests performed were Pearson's correlation, chi-square testing and logistic regression using SPSS 22.0. Results: We identified 39 patients (22 males, 17 females). Twenty four patients (61.5%) had a urological complication. Most frequent urologic complications were bacterial urinary tract infection (n = 13; 33.3%), acute renal failure (n = 6; 15.4%) and BK virus-associated haemorrhagic cystitis (n = 5; 12.8%). BK viruria was detected in 12 patients (30.8%). We observed an association of creatinine increase (about 20 µmol/l at time of onset of BK viruria) with BK viruria (Pearson's correlation 0.64; p = 0.01), and BK viruria is significantly linked to acute renal failure (Pearson's correlation 0.35; p = 0.029). In univariate regression, BK viruria is significantly linked to urological complication (p = 0.025). Conclusions: We suggest that BK virus infection during stem cell transplantation can lead to BK virus associated nephropathy, which is so far only known from patients after kidney transplantation.

Vanin 1 (VNN1) levels predict poor outcome in acute myeloid leukemia

“…Acute renal failure was described in retrospective analysis before, so we must conclude that BK virus can also lead to nephropathy in allogeneic stem cell transplantation like it is well known in kidney transplantation. 4 We found no association with polyomavirus BK and JC with GvHD contrary to what was described in other studies. 6 Regarding GvHD prophylaxis, our study was quite homogenous, since all patients received alemtuzumab.…”

“…Two patients with the dilated phenotype and HFrEF had only partial reversal of their LV dysfunction with institution of iron chelation therapy. This is similar to the findings by Odour et al 4 The absence of complete reversal of LV dysfunction may be attributed to established myocardial injury, persistent iron overload, or limited efficacy of iron chelators as only a portion of total body iron content is directly chelatable, with hemosiderin being the least accessible form of the three forms of stored iron. 5 Thus it may be postulated that in lieu of initiating iron chelation therapy when T2* values are <20 milliseconds on MRI, it may be beneficial to initiate therapy earlier when T2* values are 20-30 CORRESPONDENCE…”

“…Furthermore, expression of VNN1 was significantly higher in patients who needed two or more induction cycles with cytarabine to achieve remission in respect to those who achieved remission after the first induction, and was also linearly associated with increasing cytogenetic risk, though there was no interdependence between these two factors (P:0.955, Fisher's Exact) (Supporting Information Table S4). Furthermore, even though VNN1 is part of the leukemia stem cell (LSC) signature identified by Gentles et al, 4 we did not find any association between VNN1 and this signature (P: 0.298 for TCGA LAML, 0.999 for GSE10358 and 0.571 for TARGET-AML, Fisher's Exact).…”

Are the Polyomaviruses BK and JC Associated with Opportunistic Infections, Graft-versus-Host Disease, or Worse Outcomes in Adult Patients Receiving Their First Allogeneic Stem Cell Transplantation with Low-Dose Alemtuzumab?

“…We found no association of BKPyV with relapse or death (meaning mortality), but BKPyV still might be important for patients' morbidity or worse outcomes, as we and others have reported before [6,16]. …”

Is BK Virus-Associated Cystitis a Generalized Epithelial Disease?

“…BK viruria alone can also occur in up to 100%. Hence, research on this issue is of high clinical significance as BKHC can lead to severe morbidity or even mortality in stem cell-transplanted patients [3, 4]. …”