Journal Article

Relationship of Pretransplantation Polyoma BK Virus Serologic Findings and BK Viral Reactivation after Hematopoietic Stem Cell Transplantation

Anders S. Y. Wong, Kwok-Hung Chan, Vincent C. C. Cheng, Kwok-Yung Yuen, Yok-Lam Kwong and Anskar Y. H. Leung

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 44, issue 6, pages 830-837
Published in print March 2007 | ISSN: 1058-4838
Published online March 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/511863
Relationship of Pretransplantation Polyoma BK Virus Serologic Findings and BK Viral Reactivation after Hematopoietic Stem Cell Transplantation

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Background. Reactivation of polyoma BK virus (BKV) infection is consistently associated with hemorrhagic cystitis in persons who undergo hematopoietic stem cell transplantation (HSCT). In this study, we examined the relationship of reactivation of BKV infection with pre-HSCT serologic findings of BKV antibody.

Methods. Serial urine samples (n = 1118) obtained from 140 HSCT recipients were prospectively obtained, and BKV loads were quantified by quantitative polymerase chain reaction. Pre-HSCT anti-BKV immunoglobulin G (IgG) levels were determined by indirect immunofluorescence.

Results. In 68 patients, there was significant peaking (i.e., ⩾3-log increase) in the urine BKV load (median peak, 1.7 ×; 109 copies/mL; range, 1.1 ×; 104 to 3.2 ×; 1014 copies/mL) occurring at a median time of 24.5 days (range, 7–49 days). In 72 patients, low-level BKV viruria occurred without peaking (median BKV load, 10 copies/mL; range, 9.9 ×; 103 to 1.2 ×; 1010 copies/mL) at a median time of 24.5 days (range, 7–49 days). Pre-HSCT anti-BKV IgG was positively related to elevated urine BKV load during HSCT (P < .001). Binary logistic regression revealed that pre-HSCT anti-BKV IgG level was the only statistically significant factor (P = .009) to be associated with a ⩾3-log increase in the peak urine BKV load (positive and negative predictive values, 69% and 68%, respectively). Nine patients developed hemorrhagic cystitis at a median of 56 days (range, 29–160); 7 of these patients were evaluable and were found to have a ⩾3-log increase in the peak BKV load. In binary logistic regression, peaking of the urine BKV load (P = .026) and graft-versus-host disease (P = .033) were found to be statistically significant risks for hemorrhagic cystitis.

Conclusions. The identification of the serologic status of BKV as a significant risk factor for BKV viruria suggests that it should be included as an integral part of the pre-HSCT evaluation.

Journal Article.  4434 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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