BK virus disease after allogeneic stem cell transplantation: a cohort analysis.
The clinical epidemiology of BK virus (BKV) disease after allogeneic hematopoietic stem cell transplantation (HSCT) is not well defined. We evaluated 491 patients transplanted from January 2010 to December 2011 at a single transplant center to assess incidence, severity, and risk factors for BKV disease after HSCT. BKV disease was defined as BKV detection in urine by PCR testing in association with genitourinary symptoms without other concurrent genitourinary conditions. BKV disease occurred in 78 patients (15.9%), for an incidence rate of .47/1000 patient-days (95% confidence interval [CI], .37 to .59); BKV disease was considered severe in 27 patients (5.5%). In multivariate Cox modeling, time-dependent acute graft-versus-host disease (aGVHD) grades II to IV (adjusted hazard ratio [aHR] 4.25; 95% CI, 2.51 to 7.21), cord blood HSCT (aHR 2.28; 95% CI, 1.01 to 5.15), post-transplant mycophenolate use (aHR 3.31; 95% CI, 1.83 to 5.99), and high-dose cyclophosphamide conditioning (aHR 2.34, 95% CI 1.45 to 3.77) were significant predictors of BKV disease. Time-dependent aGVHD grades III to IV (aHR 10.5; 95% CI, 4.44 to 25.0) and cord blood HSCT (aHR 5.40; 95% CI, 1.94 to 15.0) were independent risk factors for severe BKV disease. BKV disease is common and is associated with significant and prolonged morbidity after HSCT. Prospective studies are needed to better define the morbidity of post-HSCT BKV disease and inform the design of prophylaxis and treatment trials.
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; University of Groningen Medical School, Groningen, The Netherlands.
Nienke M G
NM
Rorije
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.
Margaret M
MM
Shea
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.
Gowri
G
Satyanarayana
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Sarah P
SP
Hammond
Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Vincent T
VT
Ho
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Lindsey R
LR
Baden
Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Joseph H
JH
Antin
Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Robert J
RJ
Soiffer
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; Division of Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. Electronic address: fmarty@partners.org.
Francisco M
FM
Marty
D000328:Adult; D000368:Aged; D001739:BK Virus / Q000276:immunology; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects; D003520:Cyclophosphamide / Q000009:adverse effects; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000473:pathology; D019337:Hematologic Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives; D019653:Myeloablative Agonists / Q000009:adverse effects; D027601:Polyomavirus Infections / Q000209:etiology / Q000276:immunology / Q000473:pathology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014412:Tumor Virus Infections / Q000209:etiology / Q000276:immunology / Q000473:pathology*
D019653:Myeloablative Agonists; D003520:Cyclophosphamide; D009173:Mycophenolic Acid
Allogeneic stem cell transplantation; BK virus; Cord blood transplantation; Graft-versus-host disease; Human BK polyomavirus