The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Treatment of BK virus-associated hemorrhagic cystitis with low-dose intravenous cidofovir in patients undergoing allogeneic hematopoietic cell transplantation

  • Lee, Seung-Shin (Department of Hematology and Oncology, Chonnam National University Hwasun Hospital) ;
  • Ahn, Jae-Sook (Department of Hematology and Oncology, Chonnam National University Hwasun Hospital) ;
  • Jung, Sung-Hoon (Department of Hematology and Oncology, Chonnam National University Hwasun Hospital) ;
  • Ahn, Seo-Yeon (Department of Hematology and Oncology, Chonnam National University Hwasun Hospital) ;
  • Kim, Jae-Yong (Department of Hematology and Oncology, Chonnam National University Hwasun Hospital) ;
  • Jang, Hee-Chang (Department of Infectious Disease, Chonnam National University Hwasun Hospital) ;
  • Kang, Seung-Ji (Department of Infectious Disease, Chonnam National University Hwasun Hospital) ;
  • Jang, Mi-Ok (Department of Infectious Disease, Chonnam National University Hwasun Hospital) ;
  • Yang, Deok-Hwan (Department of Hematology and Oncology, Chonnam National University Hwasun Hospital) ;
  • Kim, Yeo-Kyeoung (Department of Hematology and Oncology, Chonnam National University Hwasun Hospital) ;
  • Lee, Je-Jung (Department of Hematology and Oncology, Chonnam National University Hwasun Hospital) ;
  • Kim, Hyeoung-Joon (Department of Hematology and Oncology, Chonnam National University Hwasun Hospital)
  • Received : 2014.03.18
  • Accepted : 2014.07.07
  • Published : 2015.03.01
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Abstract

Background/Aims: 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.

Keywords

References

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