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Abstract
Background:
Viruria is frequently detected in patients who have had hemorrhagic cystitis (HC) following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Urinary viruses, especially BK virus, have been suggested as a cause of HC following allo-HSCT, therefore antiviral therapy is emerging as a therapeutic approach for its treatment.
Methods:
Adult HC patients who underwent allo-HSCT from January 2005 to March 2006 at a single institution were enrolled. We performed a PCR-based assay for BK virus, JC virus, and CMV virus in urine obtained from the patients to determine the incidence of viruria, and the type of virus detected in the urine, and the effect of treatment with cidofovir on HC.
Results:
Of 155 patients that received allo-HSCT during the study period, 22 (14.2%) experienced HC. A viral study of urine obtained from 19 of these 22 patients revealed that 16 (84.2%) had viruria. Eleven patients had grade III-IV HC, 5 of which were treated with intravenous cidofovir. Three of the HC patients who underwent treatment responded to cidofovir, 1 had no response, and 1 had a complete response followed by recurrence.
Conclusion:
Most adult HC patients (84.2%) had viruria following allo-HSCT, however the response rate to antiviral therapy with intravenous cidofovir for the treatment of high grade HC (grade III-IV) was 80%. Therefore, antiviral therapy should be considered if high grade HC does not respond to hyperhydration and transfusional support.
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Fig. 1
Treatment outcome of hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation. Abbreviations: IVH, intravenous hyperhydration; CR, complete response; NR, no response; CBI, continuous bladder irrigation with water; rhGM-CSF, intravesical recombinant human granulocyte-macrophage colony-stimulating factor instillation; AI, intravesical alum irrigation; CDV, intravenous cidofovir; TAE, transarterial embolization.
Table 1.
Clinical characteristics of the adult patients who had hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation
∗The case that alemtuzumab was used in conditioning period is defined as in-vivo T cell depletion. Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; MM, multiple myeloma; sBMT, sibling donor bone marrow transplantation; sPB+BMT, transplantation using peripheral blood stem cell plus bone marrow stem cell from sibling donor; sPBSCT, sibling donor peripheral blood stem cell transplantation; uBMT, unrelated donor bone marrow transplantation; uPBSCT, unrelated donor peripheral blood stem cell transplantation; uCBT, unrelated donor cord blood transplantation; HaploidPBSCT, haploidentical peripheral blood stem cell transplantation; TBI, total body irradiation; N/E, not evaluable; CNS, central nervous system; HC-associated; hemorrhagic cystitis-associated.
Table 2.
Clinical grading of hemorrhagic cystitis
| Grade | Severity |
|---|---|
| I | Microscopic hematuria |
| II | Macroscopic hematuria |
| III | II+presence of blood clot |
| IV | III+renal impairment due to urinary obstructio |
Table 3.
Profound immunosuppression state and clinical courses of hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation
Abbreviations: N/E, not evaluable; BK, BK virus; JC, JC virus; CMV, cytomegalovirus; IVH, intravenous hyperhydration; CBI, continuous bladder irrigation with water; CDV, intravenous cidofovir; GMCSF, intravesical recombinant human granulocyte-macrophage colony-stimulating factor instillation; AI, intravesical alum irrigation; TAE, transarterial embolization; CR, complete response; NR, no response.
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