title: Cidofovir for BK virus-associated hemorrhagic cystitis: a retrospective study.
abstract: BACKGROUND
  BK virus-associated hemorrhagic cystitis (BKV-HC) is a severe complication after allogeneic hematopoietic stem cell transplantation (HSCT), but antiviral treatment for this condition has not been evaluated.
  
  
  METHODS
  We conducted a retrospective survey on the safety and outcome of cidofovir treatment for patients with BKV-HC in centers affiliated with the European Group for Blood and Marrow Transplantation.
  
  
  RESULTS
  From 1 April 2004 to 31 December 2007, 62 patients received a diagnosis of BKV-HC after a median interval of 35 days after HSCT (range, 3-577 days). Fifty-seven patients (92%) received intravenous cidofovir, whereas 5 patients received cidofovir intravesically. Complete response (CR) was recorded in 38 (67%) of 57 patients with HC treated with intravenous cidofovir, whereas partial response (PR) was documented in 7 patients (12%). CR was documented in 3 patients and PR in 1 patient with HC treated with intravesical cidofovir. A reduction of 1-3 logs in BKV load was documented in 8 of the 10 patients achieving CR. Mild-to-moderate toxic effects were recorded in 18 of 57 patients who received intravenous cidofovir administration. In a multivariate analysis, the factors significantly associated with response to cidofovir were the stem cell source (P = .01) and the use of total body irradiation (P = .03). After a median follow-up of 287 days, overall survival and total treatment-related mortality rates were 63% and 40% for patients achieving CR, compared with 14% and 72% for patients with PR or no response to cidofovir, respectively (P = .001 and P = .001, respectively).
  
  
  CONCLUSIONS
  Cidofovir may be a potentially effective therapy for BKV-HC, but evidence supporting its use requires randomized controlled trials.
authors.affiliation: University of Padua, Padua, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Cesaro
authors.forename: Hans H
authors.initials: HH
authors.lastname: Hirsch
authors.forename: Maura
authors.initials: M
authors.lastname: Faraci
authors.forename: Joanna
authors.initials: J
authors.lastname: Owoc-Lempach
authors.forename: Angela
authors.initials: A
authors.lastname: Beltrame
authors.forename: Andrea
authors.initials: A
authors.lastname: Tendas
authors.forename: Ioannis
authors.initials: I
authors.lastname: Baltadakis
authors.forename: Jean-Hughes
authors.initials: JH
authors.lastname: Dalle
authors.forename: Yener
authors.initials: Y
authors.lastname: Koc
authors.forename: Jacek
authors.initials: J
authors.lastname: Toporski
authors.forename: Jan
authors.initials: J
authors.lastname: Styczynski
authors.forename: M Akif
authors.initials: MA
authors.lastname: Yesilipek
authors.forename: Werner
authors.initials: W
authors.lastname: Heinz
authors.forename: Maurizio
authors.initials: M
authors.lastname: Caniglia
authors.forename: Jelena
authors.initials: J
authors.lastname: Rascon
authors.forename: Axel A
authors.initials: AA
authors.lastname: Fauser
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.forename: Lucia
authors.initials: L
authors.lastname: Lopez-Corral
authors.forename: Stefan
authors.initials: S
authors.lastname: Neuburger
authors.forename: Gloria
authors.initials: G
authors.lastname: Tridello
authors.forename: Herman
authors.initials: H
authors.lastname: Einsele
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001739:BK Virus / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D000077404:Cidofovir; D003556:Cystitis / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D003596:Cytosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006470:Hemorrhage; D006801:Humans; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D027601:Polyomavirus Infections / Q000188:drug therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000188:drug therapy* / Q000821:virology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir