Work

277: A Prospective Evaluation of the Effect of Polyoma (BK) Virus Infection on the Incidence of Hemorrhagic Cystitis (HC) after Unrelated Donor Allogeneic Hematopoietic Stem Cell Transplantation (UD HSCT)

Year: 2008

Type: article

Abstract: Background: BK virus infection is highly prevalent in humans, and has been associated with development of HC after UD HSCT. Previously we determined that UD HSCT is independently associated with higher prevalence of HC (El-Zimaity et al. Blood 2004). In order to further investigate the association of BK with HC, we hypothesized that the presence of BK virus in the urine as determined by a PCR assay before UD transplant would be associated with a higher incidence of HC. Methods: We studied prospectively 209 consecutive patients transplanted from 09/05 to 08/07. Preparative regimens were ablative (n = 118) and reduced intensity (n = 91); 38 patients (18%) received cyclophosphamide-containing regimens. GVHD prophylaxis was tacrolimus and mini-methotrexate. Stem cell source was bone marrow (n = 78), peripheral blood (n = 108) and umbilical cord (n = 23). BK virus quantitative PCR was performed on urine samples collected at admission for transplant and on days 15, 30, 45 and 60 after transplant. Results: Median age was 49 years (range, 19–71). Diagnoses were Leukemias (n = 161), Multiple Myeloma (n = 6), Hodgkin's disease (n = 7), Non-Hodgkin's Lymphomas (n = 32), and other(n = 3). Median follow-up is 246 days (range 7–848). BK PCR was positive in 96 patients(46%). Number of viral copies ranged from 200 to >200 million copies. Twenty-eight patients (13.4%) developed HC, at a median of 59 days (range 8–225) after HSCT. The 100-day cumulative incidence (using death as a competing risk) of HC in the PCR positive and negative groups was 13% versus 6% (HR 2.6; 95% CI, 1–6.9; P = 0.05). The one-year cumulative incidence of HC in the PCR positive and negative groups was 16% versus 10% (HR 2; 95% CI, 0.9–4.6; P = 0.09). Incidence of HC (table) was not statistically significantly increased among recipients of cyclophosphamide-containing regimens or among patients with grade II-IV acute GVHD. Conclusion: BK viruria pre-HSCT may increase the risk of developing HC.Tabled 1Incidence of HCHC Yes (n)%non CTX regimen2011CTX regimen410GVHD II-IV812non GVHD910Ablative regimen1815non-Ablative regimen66Stem Cell Source PBSC1312 BM67 CB521 BK PCR > 200 million copies225 BK PCR < 200 million copies1315HC: Hemorrhagic Cystitis; CTX: Cyclophosphamide; PBSC: Peripheral Blood Stem Cell; BM Bone Marrow; CB: Cord Blood. Open table in a new tab HC: Hemorrhagic Cystitis; CTX: Cyclophosphamide; PBSC: Peripheral Blood Stem Cell; BM Bone Marrow; CB: Cord Blood.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2007.12.287