Abstract
Simple SummaryDespite noticeable progress in allogeneic hematopoietic stem cell transplantation, potential viral reactivations are still one of the most challenging complications. The aim of our study was to identify predictive and risk factors associated with the occurrence of the BK virus related hemorrhagic cystitis following hematopoietic stem cell transplantation. Furthermore, we investigated the impact of various factors on the clinical course of patients after hematopoietic stem cell transplantation. We confirmed that >0.75 × 103 BK virus copies/mL in serum at day +21 after allogeneic hematopoietic stem cell transplantation has a strong predictive ability for hemorrhagic cystitis. Thus, we believe that our findings could be helpful in establishing the predictive validity of the BK viral load measurement in polyomavirus BK-associated hemorrhagic cystitis and survival.BK virus reactivation increases the likelihood of hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplant (HCT). In this study, we aimed to identify predictive and risk factors associated with the increased occurrence of this condition following HCT. On a group of 124 patients aged ≤71 years old (median 40 years) who underwent HCT, we analyzed sex, age, time from diagnosis to transplantation, type of conditioning, donor’s relationship, age, and sex, the impact of immunosuppression with different drugs, and acute and chronic GVHD, BK viremia and viruria as potential factors increasing the risk of BK-related HC after HCT. HC occurred among 24 patients (24/124; 29.2%). A significant correlation was observed between HC incidences after HCT, BK viremia and viruria, and acute GVHD occurrence. Furthermore, the level of BKV DNA in serum at day +21 (>0.75 × 103) significantly impacted the patients’ survival time. According to our results, the likelihood ratio of BKV-DNA on day +21 in serum is 6.25, indicating that this diagnostic test has the potential to be utilized in a clinical setting. These findings may be used as a voice in the discussion on implementing an optimal preemptive treatment in BKV reactivation after allogeneic HCT.
Highlights
The BK virus (BKV)-associated hemorrhagic cystitis (BK-PyVHC) is a well-recognized complication and a common cause of morbidity in patients undergoing hematopoietic cell transplantation (HCT) [1]
BKV reactivation following allogeneic HCT can lead to manifestations ranging from asymptomatic viruria to severe hemorrhagic cystitis (HC) [3]
The current literature highlights a variety of risk factors for HC following allo-HCT, including myeloablative (MAC) conditioning, unrelated donors, other than BK-HC associated viremias such as cytomegalovirus (CMV) or human herpesvirus (HHV)-6, and graft-versus-host disease (GVHD) [11,12,13]
Summary
The BK virus (BKV)-associated hemorrhagic cystitis (BK-PyVHC) is a well-recognized complication and a common cause of morbidity in patients undergoing hematopoietic cell transplantation (HCT) [1]. BKV reactivation following allogeneic HCT can lead to manifestations ranging from asymptomatic viruria to severe hemorrhagic cystitis (HC) [3]. When the BK virus reactivates in immunocompromised hosts (such as HCT or solid organ transplant recipients) or immunocompromised (such as AIDS patients), it can lead to severe clinical diseases. Several studies have attempted to recognize risk factors associated with BKV-HC [6,7,8,9]. We attempted to identify predictive and risk factors associated with the occurrence of BKV related HC following HCT. We investigated the impact of various factors on the clinical course of patients after HCT
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