Clinical course and treatment of haemorrhagic cystitis associated with BK type of human polyomavirus in nine paediatric recipients of allogeneic bone marrow transplants.
Of a total of 117 bone marrow transplant (BMT) recipients in the period from August 1988 to November 1995, 9 (7.7%) developed haemorrhagic cystitis. This condition was characterized in all nine patients by late onset (day +24 to +50 post-BMT), long duration (1 to 7 weeks), and the excretion of BK virus in the urine, as confirmed by electron microscopy, DNA hybridization and PCR analysis. Adenovirus was not involved. The serological assessment of BK virus-specific IgM and IgG pre- and post-BMT is consistent with viral reactivation in all patients, although a primary infection cannot be absolutely excluded in a single patient. A significant correlation between the use of high-dose busulphan (16 mg/kg) in the preparative regimen and development of haemorrhagic cystitis (P = 0. 0003) was evident. The severe course of the disease in two patients resulted in bladder tamponade; bleeding could not be inhibited with coagulation and laser treatment. Deterioration was prevented by bladder irrigation via a suprapubic catheter. Remission occurred spontaneously in all patients.


CONCLUSIONS
BK virus induced haemorrhagic cystitis in a paediatric bone marrow transplantation recipients is characterized by late onset, long duration, viral reactivation and correlates to high-dose busulphan. Severe bleeding could not be influenced by surgical intervention.
Peinemann
F
F
Zentrum für Kinderheilkunde, Klinik für Pädiatrische Hämatologie und Onkologie, Heinrich-Heine-Universität, Düsseldorf, Germany.
de Villiers
E M
EM
Dörries
K
K
Adams
O
O
Vögeli
T A
TA
Burdach
S
S
D000293:Adolescent; D001739:BK Virus / Q000254:growth & development / Q000302:isolation & purification; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002066:Busulfan / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003556:Cystitis / Q000628:therapy / Q000821:virology*; D005260:Female; D006474:Hemorrhagic Disorders / Q000821:virology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008297:Male; D027601:Polyomavirus Infections / Q000652:urine; D014412:Tumor Virus Infections / Q000652:urine; D014775:Virus Activation
D007166:Immunosuppressive Agents; D002066:Busulfan