title: Risk factors for hemorrhagic cystitis in pediatric allogeneic hematopoietic stem cell transplant recipients.
abstract: BACKGROUND
  Hemorrhagic cystitis (HC) results in significant morbidity among hematopoietic stem cell transplant (HSCT) recipients. Several potential causes for HC have been postulated, including viral infection, but definitive evidence is lacking, particularly in pediatric HSCT patients.
  
  
  METHODS
  Ninety pediatric HSCT recipients were prospectively tested on a weekly basis for adenovirus (ADV) and BK virus (BKV) by quantitative real-time polymerase chain reaction in blood and urine samples. Results were correlated with the occurrence of grade II-IV HC. The odds ratio (OR) of HC (95% confidence interval) for BKV ≥1 × 10(9) copies/mL of urine was 7.39 (1.52, 35.99), with a P-value of 0.013. Those with acute graft-versus-host disease (aGVHD) also had higher odds of developing HC, with an OR of 5.34. Given a 20% prevalence rate of HC, positive and negative predictive values of 29% and 95% were seen with a cutoff of 10(9) copies/mL.
  
  
  RESULTS
  BK viremia did not reach significance as a risk factor for development of HC (P = 0.06). Only 8 patients showed ADV viruria and 7 showed ADV viremia; all had low viral loads and 4 had no evidence of HC.
  
  
  CONCLUSIONS
  HC in pediatric HSCT is correlated most strongly to elevated urinary viral load of BKV and to aGVHD, but less strongly to BK viremia.
authors: Pathology Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
authors: R T
authors: RT
authors: Hayden
authors: Z
authors: Z
authors: Gu
authors: W
authors: W
authors: Liu
authors: R
authors: R
authors: Lovins
authors: K
authors: K
authors: Kasow
authors: P
authors: P
authors: Woodard
authors: K
authors: K
authors: Srivastava
authors: W
authors: W
authors: Leung
mesh_terms: D000256:Adenoviridae / Q000235:genetics; D000257:Adenoviridae Infections / Q000097:blood / Q000453:epidemiology* / Q000652:urine; D000293:Adolescent; D001739:BK Virus / Q000235:genetics; D001855:Bone Marrow Diseases / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003556:Cystitis / Q000453:epidemiology* / Q000821:virology; D004279:DNA, Viral / Q000097:blood* / Q000652:urine; D005260:Female; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006470:Hemorrhage / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D027601:Polyomavirus Infections / Q000097:blood / Q000453:epidemiology* / Q000652:urine; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D066027:Transplant Recipients; D014184:Transplantation, Homologous; D014412:Tumor Virus Infections / Q000097:blood / Q000453:epidemiology / Q000652:urine; D001745:Urinary Bladder Diseases / Q000453:epidemiology / Q000821:virology; D019562:Viral Load
chemical_list: D004279:DNA, Viral
keywords: BK virus; bone marrow transplant; hematopoietic stem cell transplant; hemorrhagic cystitis; pediatric transplant
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