title: Incidence, clinical outcome, and management of virus-induced hemorrhagic cystitis in children and adolescents after allogeneic hematopoietic cell transplantation.
abstract: We analyzed the incidence, etiology, risk factors, and clinical management of hemorrhagic cystitis (HC) in 102 children who underwent allogeneic stem cell transplantation: 28 from matched siblings, 57 from unrelated donors, and 17 from mismatched relatives. Conditioning regimens consisted of high-dose chemotherapy (n=83) or total body irradiation (n=19). In all children, urine and plasma were prospectively screened for human polyomavirus (HPV; BK virus [BKV] and JC virus [JCV]) or adenovirus (AdV) DNA with a polymerase chain reaction-based assay. Viral DNA was detected in the urine of 56 children (54.9%): BKV in 48 (47%), JCV in 4 (3.9%), and AdV in 4 (3.9%). HC occurred in 26 children (25.5%), and viruria was detected in all of them: BKV in 21 (80.8%), AdV in 4 (14.4%), and JCV in 1 (3.8%). All patients with AdV viruria developed HC. The cumulative incidence of HC in patients with HPV viruria was 0.43. The only significant risk factor for HC in patients with HPV-positive urine was conditioning with high-dose chemotherapy. Twenty-two children were treated with cidofovir, with no significant toxicity. In all treated patients but 1, the clinical symptoms were moderate, and no HC-related death was observed. We conclude that virus-induced HC is a frequent complication after allogeneic hematopoietic cell transplantation. Treatment with cidofovir is feasible, and further studies are warranted to evaluate its activity in HC mediated by BKV or JCV.
authors.affiliation: Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland. eg@pedhemat.am.wroc.pl
authors.forename: Ewa
authors.initials: E
authors.lastname: Gorczynska
authors.forename: Dominik
authors.initials: D
authors.lastname: Turkiewicz
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Rybka
authors.forename: Jacek
authors.initials: J
authors.lastname: Toporski
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kalwak
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Dyla
authors.forename: Zofia
authors.initials: Z
authors.lastname: Szczyra
authors.forename: Alicja
authors.initials: A
authors.lastname: Chybicka
mesh_terms: D000256:Adenoviridae / Q000302:isolation & purification; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D000077404:Cidofovir; D003556:Cystitis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000821:virology*; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004279:DNA, Viral / Q000097:blood / Q000652:urine; D019468:Disease Management; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006470:Hemorrhage; D006801:Humans; D015994:Incidence; D007223:Infant; D007577:JC Virus / Q000302:isolation & purification; D008297:Male; D008403:Mass Screening; D063065:Organophosphonates / Q000627:therapeutic use; D011120:Polyomavirus / Q000302:isolation & purification; D011446:Prospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014780:Viruses / Q000302:isolation & purification*
chemical_list: D004279:DNA, Viral; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir