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KMID : 0338420150300020212
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The Korean Journal of Internal Medicine
2015 Volume.30 No. 2 p.212 ~ p.218
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Treatment of BK virus-associated hemorrhagic cystitis with low-dose intravenous cidofovir in patients undergoing allogeneic hematopoietic cell transplantation
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:Lee Seung-Shin
:Ahn Jae-Sook/:Jung Sung-Hoon/:Ahn Seo-Yeon/:Kim Jae-Yong/:Jang Hee-Chang/:Kang Seung-Ji/:Jang Mi-Ok/:Yang Deok-Hwan/:Kim Yeo-Kyeoung/:Lee Je-Jung/:Kim Hyeoung-Joon
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Abstract
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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.
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KEYWORD
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Cidofovir, Hemorrhagic cystitis, BK virus
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