ECIL guidelines for the prevention, diagnosis and treatment of BK polyomavirus-associated haemorrhagic cystitis in haematopoietic stem cell transplant recipients

To define guidelines for BK polyomavirus (BKPyV)-associated haemorrhagic cystitis (BKPyV-HC) after paediatric and adult HSCT. Review of English literature and evidence-based recommendations by expert consensus. BKPyV-HC occurs in 8%-25% of paediatric and 7%-54% of adult recipients undergoing allogen...

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Published inJournal of antimicrobial chemotherapy Vol. 73; no. 1; p. 12
Main Authors Cesaro, Simone, Dalianis, Tina, Hanssen Rinaldo, Christine, Koskenvuo, Minna, Pegoraro, Anna, Einsele, Hermann, Cordonnier, Catherine, Hirsch, Hans H.
Format Journal Article
LanguageEnglish
Published England 01.01.2018
Subjects
BK Virus - drug effects
BK Virus - isolation & purification
Cystitis - diagnosis
Cystitis - drug therapy
Cystitis - prevention & control
Drug Resistance, Viral - genetics
Hematopoietic Stem Cell Transplantation - adverse effects
Humans
Polyomavirus Infections - diagnosis
Polyomavirus Infections - drug therapy
Polyomavirus Infections - prevention & control
Risk Factors
Tumor Virus Infections - diagnosis
Tumor Virus Infections - drug therapy
Tumor Virus Infections - prevention & control
Urinary Bladder - pathology
Urinary Bladder - virology
Online AccessGet full text
ISSN0305-7453
1460-2091
1460-2091
DOI10.1093/jac/dkx324

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Abstract To define guidelines for BK polyomavirus (BKPyV)-associated haemorrhagic cystitis (BKPyV-HC) after paediatric and adult HSCT. Review of English literature and evidence-based recommendations by expert consensus. BKPyV-HC occurs in 8%-25% of paediatric and 7%-54% of adult recipients undergoing allogeneic HSCT. Diagnosis requires the triad of cystitis, macro-haematuria and high urine BKPyV loads >7 log10 copies/mL, and exclusion of other relevant aetiologies. BKPyV viraemia is frequent and may serve as a more specific semiquantitative follow-up marker. No randomized controlled trials are available to inform antiviral prophylaxis or treatment. However, hyper-hydration and/or bladder irrigation showed limited prophylactic value. Fluoroquinolones are not effective for prophylaxis or treatment, but rather increase antibiotic resistance. Hyperbaric oxygen or fibrin glue is marginally effective based on small case series from correspondingly equipped centres. Although cidofovir has been reported to improve and/or reduce BKPyV viraemia or viruria, the current data do not support its regular use. BKPyV-HC remains a disabling unmet clinical need in HSCT that requires novel approaches supported by proper clinical trials.
AbstractList To define guidelines for BK polyomavirus (BKPyV)-associated haemorrhagic cystitis (BKPyV-HC) after paediatric and adult HSCT. Review of English literature and evidence-based recommendations by expert consensus. BKPyV-HC occurs in 8%-25% of paediatric and 7%-54% of adult recipients undergoing allogeneic HSCT. Diagnosis requires the triad of cystitis, macro-haematuria and high urine BKPyV loads >7 log10 copies/mL, and exclusion of other relevant aetiologies. BKPyV viraemia is frequent and may serve as a more specific semiquantitative follow-up marker. No randomized controlled trials are available to inform antiviral prophylaxis or treatment. However, hyper-hydration and/or bladder irrigation showed limited prophylactic value. Fluoroquinolones are not effective for prophylaxis or treatment, but rather increase antibiotic resistance. Hyperbaric oxygen or fibrin glue is marginally effective based on small case series from correspondingly equipped centres. Although cidofovir has been reported to improve and/or reduce BKPyV viraemia or viruria, the current data do not support its regular use. BKPyV-HC remains a disabling unmet clinical need in HSCT that requires novel approaches supported by proper clinical trials.
To define guidelines for BK polyomavirus (BKPyV)-associated haemorrhagic cystitis (BKPyV-HC) after paediatric and adult HSCT.OBJECTIVESTo define guidelines for BK polyomavirus (BKPyV)-associated haemorrhagic cystitis (BKPyV-HC) after paediatric and adult HSCT.Review of English literature and evidence-based recommendations by expert consensus.METHODSReview of English literature and evidence-based recommendations by expert consensus.BKPyV-HC occurs in 8%-25% of paediatric and 7%-54% of adult recipients undergoing allogeneic HSCT. Diagnosis requires the triad of cystitis, macro-haematuria and high urine BKPyV loads >7 log10 copies/mL, and exclusion of other relevant aetiologies. BKPyV viraemia is frequent and may serve as a more specific semiquantitative follow-up marker. No randomized controlled trials are available to inform antiviral prophylaxis or treatment. However, hyper-hydration and/or bladder irrigation showed limited prophylactic value. Fluoroquinolones are not effective for prophylaxis or treatment, but rather increase antibiotic resistance. Hyperbaric oxygen or fibrin glue is marginally effective based on small case series from correspondingly equipped centres. Although cidofovir has been reported to improve and/or reduce BKPyV viraemia or viruria, the current data do not support its regular use.RESULTSBKPyV-HC occurs in 8%-25% of paediatric and 7%-54% of adult recipients undergoing allogeneic HSCT. Diagnosis requires the triad of cystitis, macro-haematuria and high urine BKPyV loads >7 log10 copies/mL, and exclusion of other relevant aetiologies. BKPyV viraemia is frequent and may serve as a more specific semiquantitative follow-up marker. No randomized controlled trials are available to inform antiviral prophylaxis or treatment. However, hyper-hydration and/or bladder irrigation showed limited prophylactic value. Fluoroquinolones are not effective for prophylaxis or treatment, but rather increase antibiotic resistance. Hyperbaric oxygen or fibrin glue is marginally effective based on small case series from correspondingly equipped centres. Although cidofovir has been reported to improve and/or reduce BKPyV viraemia or viruria, the current data do not support its regular use.BKPyV-HC remains a disabling unmet clinical need in HSCT that requires novel approaches supported by proper clinical trials.CONCLUSIONSBKPyV-HC remains a disabling unmet clinical need in HSCT that requires novel approaches supported by proper clinical trials.
Author Cordonnier, Catherine
Hirsch, Hans H.
Koskenvuo, Minna
Hanssen Rinaldo, Christine
Pegoraro, Anna
Cesaro, Simone
Dalianis, Tina
Einsele, Hermann
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/29190347$$D View this record in MEDLINE/PubMed
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Copyright The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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1460-2091
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PublicationTitle Journal of antimicrobial chemotherapy
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Snippet To define guidelines for BK polyomavirus (BKPyV)-associated haemorrhagic cystitis (BKPyV-HC) after paediatric and adult HSCT. Review of English literature and...
To define guidelines for BK polyomavirus (BKPyV)-associated haemorrhagic cystitis (BKPyV-HC) after paediatric and adult HSCT.OBJECTIVESTo define guidelines for...
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SubjectTerms BK Virus - drug effects
BK Virus - isolation & purification
Cystitis - diagnosis
Cystitis - drug therapy
Cystitis - prevention & control
Drug Resistance, Viral - genetics
Hematopoietic Stem Cell Transplantation - adverse effects
Humans
Polyomavirus Infections - diagnosis
Polyomavirus Infections - drug therapy
Polyomavirus Infections - prevention & control
Risk Factors
Tumor Virus Infections - diagnosis
Tumor Virus Infections - drug therapy
Tumor Virus Infections - prevention & control
Urinary Bladder - pathology
Urinary Bladder - virology
Title ECIL guidelines for the prevention, diagnosis and treatment of BK polyomavirus-associated haemorrhagic cystitis in haematopoietic stem cell transplant recipients
URI https://www.ncbi.nlm.nih.gov/pubmed/29190347
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