title: A prospective study of BK-virus-associated haemorrhagic cystitis in paediatric patients undergoing allogeneic haematopoietic stem cell transplantation.
abstract: We investigated the incidence, risk factors and outcome of haemorrhagic cystitis (HC) in paediatric patients undergoing HSCT and the predictive value of BK viruria and viraemia for developing HC. Over a period of 54 months, 74 patients were recruited. The cumulative incidence of HC was 22%. Among 15 patients prospectively monitored for BK viruria and viraemia, four patients developed HC of grade > or =II. This group, which had two consecutive BK positive samples, showed a sensitivity of 100%, a specificity of 82%, a positive predictive value of 67%, and negative predictive value of 100% for developing HC. Analysed by a receiver-operator characteristic curve (ROC), a urine BK load >9 x 10(6) genomic copies/ml had a sensitivity of 95% and specificity of 90%; while a blood BK load >1 x 10(3) genomic copies/ml had a sensitivity of 40% and a specificity of 93% for HC, respectively. In univariate analysis, BK positivity was the only factor significantly associated with HC. After a median follow-up of 1.8 years, patients with HC showed a lower overall survival, 40 vs 65%, P 0.01, and a lower event-free survival, 42 vs 62%, P 0.03, compared to patients without HC. We conclude that BK detection in urine and/or plasma is a specific predictor for developing HC.
authors.affiliation: Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Padova, Italy. simone.cesaro@unipd.it
authors.forename: S
authors.initials: S
authors.lastname: Cesaro
authors.forename: C
authors.initials: C
authors.lastname: Facchin
authors.forename: G
authors.initials: G
authors.lastname: Tridello
authors.forename: C
authors.initials: C
authors.lastname: Messina
authors.forename: E
authors.initials: E
authors.lastname: Calore
authors.forename: M A
authors.initials: MA
authors.lastname: Biasolo
authors.forename: M
authors.initials: M
authors.lastname: Pillon
authors.forename: S
authors.initials: S
authors.lastname: Varotto
authors.forename: A
authors.initials: A
authors.lastname: Brugiolo
authors.forename: C
authors.initials: C
authors.lastname: Mengoli
authors.forename: G
authors.initials: G
authors.lastname: Palù
mesh_terms: D000293:Adolescent; D001739:BK Virus / Q000472:pathogenicity*; D002648:Child; D002675:Child, Preschool; D003556:Cystitis / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology*; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D027601:Polyomavirus Infections / Q000150:complications* / Q000453:epidemiology; D011446:Prospective Studies; D014184:Transplantation, Homologous / Q000009:adverse effects; D014412:Tumor Virus Infections / Q000150:complications* / Q000453:epidemiology; D019562:Viral Load; D014766:Viremia