Prevention and management of BK-virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation--a systematic review and evidence-based guidance for clinical management.
Haemorrhagic cystitis (HC) is a common and, in its severe form, potentially life-threatening complication of Haematopoietic stem cell transplantation (HSCT) in children. Recent data indicate an important role of BK virus reactivation during the time of maximal post-transplant immune suppression in the pathogenesis of late-onset HC. Treatment of HC is mainly symptomatic and often frustrating. To give clinicians guidance on prevention and treatment options and their backing by scientific evidence, we have systematically assessed the available literature and devised evidence-based guidelines. Our comprehensive review demonstrates that evidence for the most commonly used interventions (such as cidofovir, oestrogen, hyperbaric oxygen, bladder instillation with formalin, alum salts or prostaglandin) is very limited. Some of these interventions also carry significant risks. Higher level evidence exists only for 2-mercaptoethane sodium (MESNA) and hyperhydration as a preventative intervention, and for systemic recombinant Factor VII as a treatment to stop acute haemorrhage. Further high-quality studies are required to establish effective and safe prevention and treatment options for HC.
Supra-regional Children's Bone Marrow Transplant Unit (CBMTU), Newcastle General Hospital, Newcastle upon Tyne, UK. christian.harkensee@ncl.ac.uk
Christian
C
Harkensee
Nikhil
N
Vasdev
Andrew R
AR
Gennery
Ian E
IE
Willetts
Clive
C
Taylor
D000283:Administration, Intravesical; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001739:BK Virus; D002648:Child; D015653:Cystectomy; D003556:Cystitis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D004621:Embolization, Therapeutic; D004967:Estrogens / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D015942:Factor VIIa / Q000627:therapeutic use; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D006874:Hydrostatic Pressure; D006931:Hyperbaric Oxygenation; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D036341:Intercellular Signaling Peptides and Proteins / Q000627:therapeutic use; D020011:Protective Agents / Q000627:therapeutic use
D000890:Anti-Infective Agents; D000998:Antiviral Agents; D004967:Estrogens; D015718:Fibrin Tissue Adhesive; D007166:Immunosuppressive Agents; D036341:Intercellular Signaling Peptides and Proteins; D020011:Protective Agents; D015942:Factor VIIa