Cidofovir for BK virus-associated hemorrhagic cystitis: a retrospective study.
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.
Cesaro
Simone
S
University of Padua, Padua, Italy.
Hirsch
Hans H
HH
Faraci
Maura
M
Owoc-Lempach
Joanna
J
Beltrame
Angela
A
Tendas
Andrea
A
Baltadakis
Ioannis
I
Dalle
Jean-Hughes
JH
Koc
Yener
Y
Toporski
Jacek
J
Styczynski
Jan
J
Yesilipek
M Akif
MA
Heinz
Werner
W
Caniglia
Maurizio
M
Rascon
Jelena
J
Fauser
Axel A
AA
Michallet
Mauricette
M
Lopez-Corral
Lucia
L
Neuburger
Stefan
S
Tridello
Gloria
G
Einsele
Herman
H
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
D000998:Antiviral Agents; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir