Risk factors for BK virus-associated hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation: A systematic review and meta-analysis.

Abstract

BK virus-associated hemorrhagic cystitis (BKV-HC) is an intractable complication leading to higher mortality and prolonged hospitalization among allogeneic hematopoietic stem cell transplantation (allo-HCT) recipients. Therefore, identifying the potential risk factors of BKV-HC after allo-HCT is crucial to improve prognosis and for early prevention. However, the risk factors for BKV-HC remain debatable. Therefore, we conducted a systematic review and meta-analysis to identify the risk factors for BKV-HC, for early prevention of the occurrence of BKV-HC and to improve the quality of life and prognosis of allo-HCT recipients. We searched relevant studies from PubMed, EMBASE, and the Cochrane Library up to February 2023. The odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of all risk factors were calculated to evaluate their effects on the occurrence of BKV-HC. Overall, 11 studies involving 2556 allo-HCT recipients were included in this meta-analysis. All included studies were retrospective and published between 2013 and 2022. We found that male sex (OR=1.32; 95% CI, 1.07-1.62; p=.009, I2 =34%), haploidentical donor (OR=1.84; 95% CI, 1.18-2.87; p=.007, I2 =23%), myeloablative conditioning (OR=1.76; 95% CI, 1.36-2.28; p<.0001, I2 =45%), acute graft versus host disease (aGVHD) (OR=2.73; 95% CI, 2.02-3.69; p<.0001, I2 =46%), chronic graft versus host disease (cGVHD) (OR=1.71; 95% CI, 1.12-2.60; p=.01, I2 =0%), and cytomegalovirus (CMV) reactivation (OR=3.13; 95% CI, 1.12-8.78; p=.03, I2 =79%) were significantly associated with BKV-HC in the univariable analysis. Our meta-analysis indicated that male sex, haploidentical donor, myeloablative conditioning, aGVHD, cGVHD, and CMV reactivation were potential risk factors for BKV-HC.