High burden of BK virus-associated hemorrhagic cystitis in patients undergoing allogeneic hematopoietic stem cell transplantation.
BK virus (BKV) reactivation has been increasingly associated with the occurrence of late-onset hemorrhagic cystitis (HC) after allogeneic hematopoietic SCT (allo-HSCT) resulting in morbidity and sometimes mortality. We investigated the incidence, risk factors and outcome of BKV-HC in 323 consecutive adult patients undergoing allo-HSCT over a 5-year period. BK viremia values for HC staging were evaluated, as well as the medico-economic impact of the complication. Forty-three patients developed BKV-HC. In univariate analysis, young age (P=0.028), unrelated donor (P=0.0178), stem cell source (P=0.0001), HLA mismatching (P=0.0022) and BU in conditioning regimen (P=0.01) were associated with a higher risk of developing BKV-HC. In multivariate analysis, patients receiving cord blood units (CBUs) (P=0.0005) and peripheral blood stem cells (P=0.011) represented high-risk subgroups for developing BKV-HC. BK viremia was directly correlated to HC severity (P=0.011) with a 3 to 6-log peak being likely associated with grades 3 or 4 HC. No correlation was found between BKV-HC and acute graft versus host disease or mortality rate. Patients with BKV-HC required a significantly longer duration of hospitalization (P<0.0001), more RBC (P=0.0003) and platelet transfusions (P<0.0001). Over the 5-year study period, the financial cost of the complication was evaluated at \[euro]2 376 076 ($3 088 899). Strategies to prevent the occurrence of late-onset BKV-HC after allo-HSCT are urgently needed, especially in CBU and peripheral blood stem cell recipients. BK viremia correlates with the severity of the disease. Prospective studies are required to test prophylactic approaches.
Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
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L
Gilis
Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
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S
Morisset
Virology Laboratory, Laboratoire de Virologie Est, Hospices Civils de Lyon, Bron, France.
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G
Billaud
Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
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S
Ducastelle-Leprêtre
Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
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H
Labussière-Wallet
Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
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FE
Nicolini
Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
F
F
Barraco
Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
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M
Detrait
Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
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X
Thomas
Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
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N
Tedone
Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
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M
Sobh
Infectious Diseases Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
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C
Chidiac
1] Infectious Diseases Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France [2] Inserm U1111 CIRI, Claude Bernard Lyon I University, Lyon, France.
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T
Ferry
Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
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G
Salles
Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
M
M
Michallet
1] Infectious Diseases Department, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France [2] Inserm U1111 CIRI, Claude Bernard Lyon I University, Lyon, France.
F
F
Ader
D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001739:BK Virus; D000077404:Cidofovir; D003556:Cystitis / Q000191:economics / Q000453:epidemiology / Q000821:virology*; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006086:Graft vs Host Disease / Q000191:economics / Q000453:epidemiology; D017048:Health Care Costs; D019337:Hematologic Neoplasms / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use; D027601:Polyomavirus Infections / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D012307:Risk Factors; D014184:Transplantation, Homologous; D014412:Tumor Virus Infections / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D014766:Viremia / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D055815:Young Adult
D000998:Antiviral Agents; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir