title: Hemorrhagic cystitis after allogeneic hematopoietic stem cell transplants is the complex result of BK virus infection, preparative regimen intensity and donor type.
abstract: BACKGROUND
  Hemorrhagic cystitis is a common cause of morbidity after allogeneic stem cell transplantation, frequently associated with BK virus infection. We hypothesized that patients with positive BK viruria before unrelated or mismatched related donor allogeneic hematopoietic stem cell transplantation have a higher incidence of hemorrhagic cystitis.
  
  
  METHODS
  To test this hypothesis, we prospectively studied 209 patients (median age 49 years, range 19-71) with hematologic malignancies who received bone marrow (n=78), peripheral blood (n=108) or umbilical cord blood (n=23) allogeneic hematopoietic stem cell transplantation after myeloablative (n=110) or reduced intensity conditioning (n=99). Donors were unrelated (n=201) or haploidentical related (n=8).
  
  
  RESULTS
  Twenty-five patients developed hemorrhagic cystitis. Pre-transplant BK viruria detected by quantitative PCR was positive in 96 patients. The one-year cumulative incidence of hemorrhagic cystitis was 16% in the PCR-positive group versus 9% in the PCR-negative group (P=0.1). The use of umbilical cord blood or a haploidentical donor was the only significant predictor of the incidence of hemorrhagic cystitis on univariate analysis. There was also a trend for a higher incidence after myeloablative conditioning. Multivariate analysis showed that patients who had a positive PCR pre-transplant and received haploidentical or cord blood grafts with myeloablative conditioning had a significantly higher risk of developing hemorrhagic cystitis (58%) than all other recipients (7%, P<0.001).
  
  
  CONCLUSIONS
  Hemorrhagic cystitis is the result of a complex interaction of donor type, preparative regimen intensity, and BK viruria.
authors.affiliation: Department of Stem Cell Transplantation & Cell Therapy, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA.
authors.forename: Leandro de Padua
authors.initials: Lde P
authors.lastname: Silva
authors.forename: Poliana A
authors.initials: PA
authors.lastname: Patah
authors.forename: Rima M
authors.initials: RM
authors.lastname: Saliba
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Szewczyk
authors.forename: Lisa
authors.initials: L
authors.lastname: Gilman
authors.forename: Joyce
authors.initials: J
authors.lastname: Neumann
authors.forename: Xiang-Yang
authors.initials: XY
authors.lastname: Han
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tarrand
authors.forename: Rachel
authors.initials: R
authors.lastname: Ribeiro
authors.forename: Alison
authors.initials: A
authors.lastname: Gulbis
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Shpall
authors.forename: Roy
authors.initials: R
authors.lastname: Jones
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
authors.forename: Julia A
authors.initials: JA
authors.lastname: Walker
authors.forename: Demetrios
authors.initials: D
authors.lastname: Petropoulos
authors.forename: Alexandre
authors.initials: A
authors.lastname: Chiattone
authors.forename: John
authors.initials: J
authors.lastname: Stewart
authors.forename: Maha
authors.initials: M
authors.lastname: El-Zimaity
authors.forename: Paolo
authors.initials: P
authors.lastname: Anderlini
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
mesh_terms: D000328:Adult; D000368:Aged; D001739:BK Virus; D003556:Cystitis / Q000209:etiology* / Q000473:pathology; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006470:Hemorrhage; D006801:Humans; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000150:complications* / Q000209:etiology; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014184:Transplantation, Homologous; D014412:Tumor Virus Infections / Q000150:complications* / Q000209:etiology; D055815:Young Adult
references.citation: J Urol. 1984 Sep;132(3):580-2
references.pmid: 6433044
references.citation: J Clin Oncol. 1995 May;13(5):1103-9
references.pmid: 7738616
references.citation: J Clin Microbiol. 2004 Nov;42(11):5394-6
references.pmid: 15528753
references.citation: Bone Marrow Transplant. 2003 Dec;32(11):1089-95
references.pmid: 14625581
references.citation: Haematologica. 2006 Mar;91(3):401-4
references.pmid: 16531266
references.citation: Urology. 1982 Sep;20(3):256-8
references.pmid: 7123717
references.citation: Bone Marrow Transplant. 2008 Jan;41(1):11-8
references.pmid: 17952131
references.citation: Anticancer Res. 2006 Mar-Apr;26(2B):1311-8
references.pmid: 16619539
references.citation: Transplantation. 1987 Jan;43(1):108-12
references.pmid: 3026070
references.citation: J Med Virol. 1982;10(2):91-9
references.pmid: 6292361
references.citation: Acta Cytol. 2008 Mar-Apr;52(2):191-5
references.pmid: 18499992
references.citation: J Clin Oncol. 1991 Nov;9(11):2016-20
references.pmid: 1941060
references.citation: Bone Marrow Transplant. 2008 Apr;41(8):737-42
references.pmid: 18176615
references.citation: Blood. 2001 Sep 15;98(6):1971-8
references.pmid: 11535537
references.citation: Bone Marrow Transplant. 1996 Apr;17(4):573-6
references.pmid: 8722357
references.citation: Transplantation. 1993 Oct;56(4):875-9
references.pmid: 8212210
references.citation: Pediatr Transplant. 1998 Nov;2(4):288-93
references.pmid: 10084731
references.citation: Biol Blood Marrow Transplant. 2005 Oct;11(10):797-804
references.pmid: 16182180
references.citation: Blood. 2004 Jun 15;103(12):4674-80
references.pmid: 14726405
references.citation: Bone Marrow Transplant. 2005 Dec;36(11):929-37
references.pmid: 16184185
references.citation: Int J Hematol. 2006 Oct;84(3):268-71
references.pmid: 17050203
references.citation: N Engl J Med. 1986 Jul 24;315(4):230-4
references.pmid: 3014334
references.citation: J Clin Virol. 1999 Oct;14(2):79-86
references.pmid: 10588450
references.citation: J Gen Virol. 2006 Oct;87(Pt 10):2951-2960
references.pmid: 16963754
references.citation: Blood. 2005 Aug 1;106(3):1130-2
references.pmid: 15845896