Korean J Intern Med.  2015 Mar;30(2):212-218. 10.3904/kjim.2015.30.2.212.

Treatment of BK virus-associated hemorrhagic cystitis with low-dose intravenous cidofovir in patients undergoing allogeneic hematopoietic cell transplantation

• Lee SS
• Ahn JS
• Jung SH
• Ahn SY
• Kim JY
• Jang HC
• Kang SJ
• Jang MO
• Yang DH
• Kim YK
• Lee JJ
• Kim HJ

• KMID: 2160686
• DOI: http://doi.org/10.3904/kjim.2015.30.2.212

Abstract

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.

Keyword

Cidofovir; Hemorrhagic cystitis; BK virus

MeSH Terms

Administration, Intravenous
Adult
Antiviral Agents/*administration & dosage/adverse effects
BK Virus/*drug effects/immunology
Cystitis/diagnosis/*drug therapy/immunology/virology
Cytosine/administration & dosage/adverse effects/*analogs & derivatives
Drug Administration Schedule
Female
Hematopoietic Stem Cell Transplantation/*adverse effects
Humans
Immunocompromised Host
Male
Organophosphonates/*administration & dosage/adverse effects
Polyomavirus Infections/diagnosis/*drug therapy/immunology/virology
Retrospective Studies
Time Factors
Transplantation, Homologous
Treatment Outcome
Tumor Virus Infections/diagnosis/*drug therapy/immunology/virology
Viral Load
Antiviral Agents
Cytosine
Organophosphonates