Cidofovir for BK Virus-Associated Hemorrhagic Cystitis: A Retrospective Study

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Abstract

Background. BK virus-associated hemorrhagic cystitis (BKV-HC) is a severe complication after allogeneic hematopoietic stem cell transplantation (HSCT), but antiviral treatment for this condition has not been evaluated. Methods. We conducted a retrospective survey on the safety and outcome of cidofovir treatment for patients with BKV-HC in centers affiliated with the European Group for Blood and Marrow Transplantation. Results. From 1 April 2004 to 31 December 2007, 62 patients received a diagnosis of BKV-HC after a median interval of 35 days after HSCT (range, 3-577 days). Fifty-seven patients (92%) received intravenous cidofovir, whereas 5 patients received cidofovir intravesically. Complete response (CR) was recorded in 38 (67%) of 57 patients with HC treated with intravenous cidofovir, whereas partial response (PR) was documented in 7 patients (12%). CR was documented in 3 patients and PR in 1 patient with HC treated with intravesical cidofovir. A reduction of 1-3 logs in BKV load was documented in 8 of the 10 patients achieving CR. Mild-to-moderate toxic effects were recorded in 18 of 57 patients who received intravenous cidofovir administration. In a multivariate analysis, the factors significantly associated with response to cidofovir were the stem cell source (Pp. 01) and the use of total body irradiation (P = .03). After a median follow-up of 287 days, overall survival and total treatment-related mortality rates were 63% and 40% for patients achieving CR, compared with 14% and 72% for patients with PR or no response to cidofovir, respectively (P < .001 and P = .001, respectively). Conclusions. Cidofovir may be a potentially effective therapy for BKV-HC, but evidence supporting its use requires randomized controlled trials.

Details

Authors
  • Simone Cesaro
  • Hans H. Hirsch
  • Maura Faraci
  • Joanna Owoc-Lempach
  • Angela Beltrame
  • Andrea Tendas
  • Ioannis Baltadakis
  • Jean-Hughes Dalle
  • Yener Koc
  • Jacek Toporski
  • Jan Styczynski
  • M. Akif Yesilipek
  • Werner Heinz
  • Maurizio Caniglia
  • Jelena Rascon
  • Axel A. Fauser
  • Mauricette Michallet
  • Lucia Lopez-Corral
  • Stefan Neuburger
  • Gloria Tridello
  • And 1 others
  • Herman Einsele
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Infectious Medicine
Original languageEnglish
Pages (from-to)233-240
JournalClinical Infectious Diseases
Volume49
Issue number2
Publication statusPublished - 2009
Publication categoryResearch
Peer-reviewedYes