title: Dynamics of BKPyV reactivation and risk of hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation.
abstract: OBJECTIVE
  Aim of this retrospective study was to analyze the dynamics of BKPyV reactivation in allogeneic hematopoietic stem cell transplant recipients in order to identify patients with higher risk to develop BKPyV-associated hemorrhagic cystitis (BKPyV-associated HC).
  
  
  METHODS
  The study included 58 allo-HSCT recipients from the University Hospital of Cologne detected BKPyV positive by real-time PCR between 2009 and 2015. For correlative analysis, the first detected BKPyV-DNA load in urine and in plasma as well as the onset and severity of HC following the first day of conditioning regimen was considered. Phylogenetic analysis of BKPyV isolates was performed.
  
  
  RESULTS
  In 25 of 58 patients, BKPyV-DNA was detected in urine only (group U), whereas 33 patients developed additional viremia (group P). A chronologic sequence viruria-viremia-HC was identified. Viral load of >106copies/mL at first viruria and evidence of viremia after 45 days from the start of conditioning represented risk factors for the onset of HC. Molecular characterization revealed a non-stereotypic distribution of viral subtypes across groups U and P.
  
  
  CONCLUSIONS
  Monitoring of BKPyV-DNA by real-time PCR after initiation of conditioning, regularly performed in clinical practice, can be a crucial tool for the early identification of patients with higher risk of BKPyV-associated HC.
authors.affiliation: Institute of Virology, University of Cologne, Cologne, Germany.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Höller
authors.affiliation: National Institute for Infectious Diseases L. Spallanzani - IRCCS, Rome, Italy.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Fabeni
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology (CIO) Köln-Bonn and Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), University Hospital of Cologne, Cologne, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Herling
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology (CIO) Köln-Bonn and Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), University Hospital of Cologne, Cologne, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Holtick
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology (CIO) Köln-Bonn and Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), University Hospital of Cologne, Cologne, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Scheid
authors.affiliation: Institute of Virology, University of Cologne, Cologne, Germany.
authors.forename: Elena
authors.initials: E
authors.lastname: Knops
authors.affiliation: Institute of Virology, University of Cologne, Cologne, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Lübke
authors.affiliation: Institute of Virology, University of Cologne, Cologne, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Kaiser
authors.affiliation: Institute of Virology, University of Cologne, Cologne, Germany.
authors.forename: Herbert
authors.initials: H
authors.lastname: Pfister
authors.affiliation: Institute of Virology, University of Cologne, Cologne, Germany.
authors.forename: Veronica
authors.identifier: http://orcid.org/0000-0003-1604-8386
authors.initials: V
authors.lastname: Di Cristanziano
mesh_terms: D000328:Adult; D000368:Aged; D003556:Cystitis / Q000175:diagnosis / Q000209:etiology*; D004279:DNA, Viral; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D011120:Polyomavirus / Q000145:classification / Q000502:physiology*; D027601:Polyomavirus Infections / Q000150:complications* / Q000175:diagnosis / Q000821:virology*; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014184:Transplantation, Homologous; D019562:Viral Load; D014775:Virus Activation; D017735:Virus Latency; D055815:Young Adult
chemical_list: D004279:DNA, Viral
keywords: BKPyV; BKPyV subtype; hematopoietic stem cell transplantation; hemorrhagic cystitis; immunosuppression; latent infection; polyomavirus; viral reactivation