Hemorrhagic cystitis after allogeneic hematopoietic stem cell transplants is the complex result of BK virus infection, preparative regimen intensity and donor type.
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.
Silva
Leandro de Padua
Lde P
Department of Stem Cell Transplantation & Cell Therapy, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA.
Patah
Poliana A
PA
Saliba
Rima M
RM
Szewczyk
Nicholas A
NA
Gilman
Lisa
L
Neumann
Joyce
J
Han
Xiang-Yang
XY
Tarrand
Jeffrey
J
Ribeiro
Rachel
R
Gulbis
Alison
A
Shpall
Elizabeth J
EJ
Jones
Roy
R
Popat
Uday
U
Walker
Julia A
JA
Petropoulos
Demetrios
D
Chiattone
Alexandre
A
Stewart
John
J
El-Zimaity
Maha
M
Anderlini
Paolo
P
Giralt
Sergio
S
Champlin
Richard E
RE
de Lima
Marcos
M
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
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