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Daily low dose intravesical cidofovir for the treatment of BK virus associated hemorrhagic cystitis after allogeneic stem cell transplantation

Published:September 28, 2022DOI:https://doi.org/10.1016/j.jiac.2022.09.014

      Abstract

      Introduction

      BK virus associated hemorrhagic cystitis(BKV-AHC) is a serious complication observed after allogeneic stem cell transplantation and the current therapeutic options are scarce with substantial renal side effects. Although the guidelines recommend intravenous cidofovir application with caution to nephrotoxicity, there are few studies which investigated intravesical administration and reported similar therapeutic results with less renal side effects. Methods: We administered low dose, daily and consecutive (75 mg/day, for 5 days) intravesical cidofovir to 25 patients with BKV-AHC that developed after (ASCT). Results: The response rate in our cohort was 92% and relapse was not encountered in 84% of the patient population during one year of follow-up. The median BK urine viral load significantly decreased from 260,000,000 IU/mL to 53,000,000 IU/mL after a week of treatment (p = 0.0001). Rise in serum creatinine was observed in 5 patients during treatment and post-treatment nephrotoxicity was seen in only 1 patient. Conclusions: Daily low dose intravesical cidofovir might be an effective treatment option for BKV-AHC after ASCT with favorable less systemic side effects.

      Keywords

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      References

        • Fanourgiakis P.
        • Georgala A.
        • Vekemans M.
        • Triffet A.
        • De Bruyn J.-M.
        • Duchateau V.
        • et al.
        Intravesical instillation of cidofovir in the treatment of hemorrhagic cystitis caused by adenovirus type 11 in a bone marrow transplant recipient.
        Clin Infect Dis. 2005; 40: 199-201
        • Mori Y.
        • Miyamoto T.
        • Kato K.
        • Kamezaki K.
        • Kuriyama T.
        • Oku S.
        • et al.
        Different risk factors related to adenovirus- or BK virus-associated hemorrhagic cystitis following allogeneic stem cell transplantation.
        Biol Blood Marrow Transplant. 2012; 18: 458-465
        • Kaphan E.
        • Germi R.
        • Bailly S.
        • Bulabois C.-E.
        • Carré M.
        • Cahn J.-Y.
        • et al.
        Risk factors of BK viral hemorrhagic cystitis in allogenic hematopoietic stem cell transplantation.
        Transpl Infect Dis. 2021; 23e13601
        • Cesaro S.
        • Dalianis T.
        • Hanssen Rinaldo C.
        • Koskenvuo M.
        • Pegoraro A.
        • Einsele H.
        • et al.
        ECIL guidelines for the prevention, diagnosis and treatment of BK polyomavirus-associated haemorrhagic cystitis in haematopoietic stem cell transplant recipients.
        J Antimicrob Chemother. 2018; 73: 12-21
        • Tooker G.
        • Badros A.Z.
        • Nishioka J.
        • Riedel D.
        Intravesicular cidofovir in the treatment of BK virus-associated hemorrhagic cystitis (BKV-HC) following allogeneic hematopoietic stem cell transplant (HSCT).
        Blood. 2018; 132: 2085
        • Hirsch H.H.
        • Steiger J.
        • Polyomavirus B.K.
        Lancet Infect Dis. 2003; 3: 611-623
        • Bedi A.
        • Miller C.B.
        • Hanson J.L.
        • Goodman S.
        • Ambinder R.F.
        • Charache P.
        • et al.
        Association of BK virus with failure of prophylaxis against hemorrhagic cystitis following bone marrow transplantation.
        J Clin Oncol. 1995; 13: 1103-1109
        • Sakurada M.
        • Kondo T.
        • Umeda M.
        • Kawabata H.
        Successful treatment with intravesical cidofovir for virus-associated hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation: a case report and a.
        J Infect. 2016; 22: 495-500
        • Mayer K.
        • Schumacher M.
        • Eis-Hübinger A.M.
        • Pietzonka S.
        • Drosten C.
        • Brossart P.
        • et al.
        Intravesical cidofovir application in BK virus cystitis after allogeneic hematopoetic stem cell transplantation (HSCT) is safe and highly effective.
        Bone Marrow Transplant. 2018; 53: 495-498
        • Savona M.R.
        • Newton D.
        • Frame D.
        • Levine J.E.
        • Mineishi S.
        • Kaul D.R.
        Low-dose cidofovir treatment of BK virus-associated hemorrhagic cystitis in recipients of hematopoietic stem cell transplant.
        Bone Marrow Transplant. 2007; 39: 783-787
        • Koskenvuo M.
        • Dumoulin A.
        • Lautenschlager I.
        • Auvinen E.
        • Mannonen L.
        • Anttila V.-J.
        • et al.
        BK polyomavirus-associated hemorrhagic cystitis among pediatric allogeneic bone marrow transplant recipients: treatment response and evidence for nosocomial transmission.
        J Clin Virol. 2013; 56: 77-81
        • Awdishu L.
        • Mehta R.L.
        The 6R's of drug induced nephrotoxicity.
        BMC Nephrol. 2017; 18: 124
        • Gratwohl A.
        • Hermans J.
        • Goldman J.M.
        • Arcese W.
        • Carreras E.
        • Devergie A.
        • et al.
        Risk assessment for patients with chronic myeloid leukaemia before allogeneic blood or marrow transplantation. Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation.
        Lancet. 1998; 352: 1087-1092
        • Coomes E.A.
        • Wolfe Jacques A.
        • Michelis F.V.
        • Kim D.D.H.
        • Thyagu S.
        • Viswabandya A.
        • et al.
        Efficacy of cidofovir in treatment of BK virus-induced hemorrhagic cystitis in allogeneic hematopoietic cell transplant recipients.
        Biol Blood Marrow Transplant. 2018; 24: 1901-1905
        • Palacio D.
        • Prakash K.
        • Riedel D.J.
        Review of intravesicular cidofovir for BK virus hemorrhagic cystitis.
        Curr Treat Options Infect Dis. 2021; 13: 100-110
        • Aitken S.L.
        • Zhou J.
        • Ghantoji S.S.
        • Kontoyiannis D.P.
        • Jones R.B.
        • Tam V.H.
        • et al.
        Pharmacokinetics and safety of intravesicular cidofovir in allogeneic HSCT recipients.
        J Antimicrob Chemother. 2016; 71: 727-730
        • Rao K.V.
        • Buie L.W.
        • Shea T.
        • Gabriel D.A.
        • Comeau T.
        • Irons R.
        • et al.
        Intravesicular cidofovir for the management of BK virus-associated cystitis.
        Biol Blood Marrow Transplant. 2009; 15: 391-392
        • Schneidewind L.
        • Neumann T.
        • Schmidt C.A.
        • Krüger W.
        Comparison of intravenous or intravesical cidofovir in the treatment of BK polyomavirus-associated hemorrhagic cystitis following adult allogeneic stem cell transplantation-A systematic review.
        Transpl Infect Dis. 2018; 20e12914