Low-dose cidofovir treatment of BK virus-associated hemorrhagic cystitis in recipients of hematopoietic stem cell transplant.
In recipients of hematopoietic stem cell transplants (HSCTs), BK virus (BKV) has been associated with late-onset hemorrhagic cystitis (HC). In our institution, HSCT recipients with BKV-associated HC are treated with 1 mg/kg of cidofovir weekly. We identified HSCT recipients with BKV-associated HC, treated with weekly cidofovir. Microbiological response was defined as at least a one log reduction in urinary BKV viral load; clinical response was defined as improvement in symptoms and stability or reduction in the grade of cystitis. Nineteen allogeneic HSCT patients received a mean of 4.5 weekly doses of cidofovir. HC occurred at a mean of 68.7 days after transplant. A clinical response was detected in 16/19 (84%) patients, and 9/19 (47%) had a measurable microbiological response (8/10 nonresponders had a BKV viral load above the upper limit of the assay before treatment). Fourteen out of nineteen (74%) patients had no significant increase in serum creatinine. Five patients with renal dysfunction resolved after completion of the therapy and removal of other nephrotoxic agents. We conclude that weekly low-dose cidofovir appears to be a safe treatment option for BKV-associated HC. Although the efficacy of low-dose cidofovir is not proven, a prospective trial is warranted.
Savona
M R
MR
Division of Hematology-Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Newton
D
D
Frame
D
D
Levine
J E
JE
Mineishi
S
S
Kaul
D R
DR
D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D001739:BK Virus / Q000187:drug effects*; D000077404:Cidofovir; D003556:Cystitis / Q000188:drug therapy* / Q000821:virology; D003596:Cytosine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006470:Hemorrhage / Q000821:virology; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D063065:Organophosphonates / Q000008:administration & dosage*; D027601:Polyomavirus Infections / Q000188:drug therapy*; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000188:drug therapy*
D000998:Antiviral Agents; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir