Treatment of BK virus-associated hemorrhagic cystitis with low-dose intravenous cidofovir in patients undergoing allogeneic hematopoietic cell transplantation.
OBJECTIVE
BK virus (BKV) has been associated with late-onset hemorrhagic cystitis (HC) in recipients of hematopoietic stem cell transplantation (HSCT). Cidofovir has been used at higher doses (3 to 5 mg/kg/wk) with probenecid prophylaxis; however, cidofovir may result in nephrotoxicity or cytopenia at high doses.


METHODS
Allogeneic HSCT recipients with BKV-associated HC are treated with 1 mg/kg intravenous cidofovir weekly at our institution. A microbiological response was defined as at least a one log reduction in urinary BKV viral load, and a clinical response was defined as improvement in symptoms and stability or reduction in cystitis grade.


RESULTS
Eight patients received a median of 4 weekly (range, 2 to 11) doses of cidofovir. HC occurred a median 69 days (range, 16 to 311) after allogeneic HSCT. A clinical response was detected in 7/8 patients (86%), and 4/5 (80%) had a measurable microbiological response. One patient died of uncontrolled graft-versus-host disease; therefore, we could not measure the clinical response to HC treatment. One microbiological non-responder had a stable BKV viral load with clinical improvement. Only three patients showed transient grade 2 serum creatinine toxicities, which resolved after completion of concomitant calcineurin inhibitor treatment.


CONCLUSIONS
Weekly intravenous low-dose cidofovir without probenecid appears to be a safe and effective treatment option for patients with BKV-associated HC.
Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Seung-Shin
SS
Lee
Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Jae-Sook
JS
Ahn
Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Sung-Hoon
SH
Jung
Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Seo-Yeon
SY
Ahn
Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Jae-Yong
JY
Kim
Department of Infectious Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Hee-Chang
HC
Jang
Department of Infectious Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Seung-Ji
SJ
Kang
Department of Infectious Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Mi-Ok
MO
Jang
Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Deok-Hwan
DH
Yang
Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Yeo-Kyeoung
YK
Kim
Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Je-Jung
JJ
Lee
Department of Hematology and Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Hyeoung-Joon
HJ
Kim
D061605:Administration, Intravenous; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001739:BK Virus / Q000187:drug effects* / Q000276:immunology; D000077404:Cidofovir; D003556:Cystitis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D003596:Cytosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004334:Drug Administration Schedule; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D063065:Organophosphonates / Q000008:administration & dosage* / Q000009:adverse effects; D027601:Polyomavirus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D019562:Viral Load
D000998:Antiviral Agents; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir
BK virus; Cidofovir; Hemorrhagic cystitis