Journal Article

Cidofovir for BK Virus-Associated Hemorrhagic Cystitis: A Retrospective Study

Simone Cesaro, Hans H. Hirsch, Maura Faraci, Joanna Owoc-Lempach, Angela Beltrame, Andrea Tendas, Ioannis Baltadakis, Jean-Hughes Dalle, Yener Koc, Jacek Toporski, Jan Styczynski, M. Akif Yesilipek, Werner Heinz, Maurizio Caniglia, Jelena Rascon, Axel A. Fauser, Mauricette Michallet, Lucia Lopez Corral, Stefan Neuburger, Gloria Tridello and Herman Einsele

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 49, issue 2, pages 233-240
Published in print July 2009 | ISSN: 1058-4838
Published online July 2009 | e-ISSN: 1537-6591 | DOI: https://dx.doi.org/10.1086/599829
Cidofovir for BK Virus-Associated Hemorrhagic Cystitis: A Retrospective Study

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Background.BK virus-associated hemorrhagic cystitis (BKV-HC) is a severe complication after allogeneic hematopoietic stem cell transplantation (HSCT), but antiviral treatment for this condition has not been evaluated.

Methods.We conducted a retrospective survey on the safety and outcome of cidofovir treatment for patients with BKV-HC in centers affiliated with the European Group for Blood and Marrow Transplantation.

Results.From 1 April 2004 to 31 December 2007, 62 patients received a diagnosis of BKV-HC after a median interval of 35 days after HSCT (range, 3-577 days). Fifty-seven patients (92%) received intravenous cidofovir, whereas 5 patients received cidofovir intravesically. Complete response (CR) was recorded in 38 (67%) of 57 patients with HC treated with intravenous cidofovir, whereas partial response (PR) was documented in 7 patients (12%). CR was documented in 3 patients and PR in 1 patient with HC treated with intravesical cidofovir. A reduction of 1-3 logs in BKV load was documented in 8 of the 10 patients achieving CR. Mild-to-moderate toxic effects were recorded in 18 of 57 patients who received intravenous cidofovir administration. In a multivariate analysis, the factors significantly associated with response to cidofovir were the stem cell source (P=.01) and the use of total body irradiation (P=.03). After a median follow-up of 287 days, overall survival and total treatment-related mortality rates were 63% and 40% for patients achieving CR, compared with 14% and 72% for patients with PR or no response to cidofovir, respectively (P<.001 and P=.001, respectively).

Conclusions.Cidofovir may be a potentially effective therapy for BKV-HC, but evidence supporting its use requires randomized controlled trials.

Journal Article.  4437 words.  Illustrated.

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

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