Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients
BK virus (BKV)-related haemorrhagic cystitis (HC) is an important cause of morbidity following allogeneic haematopoietic stem cell transplantation (HSCT). The various risk factors include high-level BKV viruria and/or viremia, myeloablative conditioning, acute graft versus host disease (GVHD), cytom...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2021-02-01
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| Series: | Therapeutic Advances in Infectious Disease |
| Online Access: | https://doi.org/10.1177/2049936121991377 |
| _version_ | 1818580049917378560 |
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| author | Aditya Jandial Kundan Mishra Rajeev Sandal Kamal Kant Sahu |
| author_facet | Aditya Jandial Kundan Mishra Rajeev Sandal Kamal Kant Sahu |
| author_sort | Aditya Jandial |
| collection | DOAJ |
| description | BK virus (BKV)-related haemorrhagic cystitis (HC) is an important cause of morbidity following allogeneic haematopoietic stem cell transplantation (HSCT). The various risk factors include high-level BKV viruria and/or viremia, myeloablative conditioning, acute graft versus host disease (GVHD), cytomegalovirus viremia, and unrelated or HLA-mismatched donor. The presence of high plasma BK viral load and cytopenias have been implicated as important predictors for protracted disease course. These patients frequently require hospitalisation which may extend for several weeks. Supportive measures in the form of analgesics, intravenous hydration, bladder irrigation, and transfusion support remain the mainstay of management. Various drugs have been used with limited success in this setting. These include antiviral drugs, fluoroquinolones, leflunomide, growth factors, clotting factors, estrogens, and prostaglandins. The role of adoptive cellular immunotherapy has also been explored but lacks clinical validation. The strategies aimed at expediting urothelial repair like hyperbaric oxygen therapy (HBOT), intravesical fibrin glue and platelet-rich plasma (PRP) are emerging. Some patients with severe disease do require surgical intervention to relieve urinary obstruction. The frequent co-occurrence of acute GVHD and CMV disease further complicates the management in such patients. There is an unmet need for effective and evidence-based options for the prevention and management of this disease. Due to lack of robust data supported by randomised trials, the acceptability of the available guidelines to simplify the treatment is expected to be low. Despite the availability of various treatment options, the management of BKV-related HC in day-to-day practice continues to be a challenge. The aim of this article is to put forward an up-to-date review of the preventive and therapeutic strategies for BKV-related HC. |
| first_indexed | 2024-12-16T07:11:25Z |
| format | Article |
| id | doaj.art-a58ac4f5fea2476dba861a93458b8d9d |
| institution | Directory Open Access Journal |
| issn | 2049-937X |
| language | English |
| last_indexed | 2024-12-16T07:11:25Z |
| publishDate | 2021-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Infectious Disease |
| spelling | doaj.art-a58ac4f5fea2476dba861a93458b8d9d2022-12-21T22:39:53ZengSAGE PublishingTherapeutic Advances in Infectious Disease2049-937X2021-02-01810.1177/2049936121991377Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipientsAditya JandialKundan MishraRajeev SandalKamal Kant SahuBK virus (BKV)-related haemorrhagic cystitis (HC) is an important cause of morbidity following allogeneic haematopoietic stem cell transplantation (HSCT). The various risk factors include high-level BKV viruria and/or viremia, myeloablative conditioning, acute graft versus host disease (GVHD), cytomegalovirus viremia, and unrelated or HLA-mismatched donor. The presence of high plasma BK viral load and cytopenias have been implicated as important predictors for protracted disease course. These patients frequently require hospitalisation which may extend for several weeks. Supportive measures in the form of analgesics, intravenous hydration, bladder irrigation, and transfusion support remain the mainstay of management. Various drugs have been used with limited success in this setting. These include antiviral drugs, fluoroquinolones, leflunomide, growth factors, clotting factors, estrogens, and prostaglandins. The role of adoptive cellular immunotherapy has also been explored but lacks clinical validation. The strategies aimed at expediting urothelial repair like hyperbaric oxygen therapy (HBOT), intravesical fibrin glue and platelet-rich plasma (PRP) are emerging. Some patients with severe disease do require surgical intervention to relieve urinary obstruction. The frequent co-occurrence of acute GVHD and CMV disease further complicates the management in such patients. There is an unmet need for effective and evidence-based options for the prevention and management of this disease. Due to lack of robust data supported by randomised trials, the acceptability of the available guidelines to simplify the treatment is expected to be low. Despite the availability of various treatment options, the management of BKV-related HC in day-to-day practice continues to be a challenge. The aim of this article is to put forward an up-to-date review of the preventive and therapeutic strategies for BKV-related HC.https://doi.org/10.1177/2049936121991377 |
| spellingShingle | Aditya Jandial Kundan Mishra Rajeev Sandal Kamal Kant Sahu Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients Therapeutic Advances in Infectious Disease |
| title | Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients |
| title_full | Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients |
| title_fullStr | Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients |
| title_full_unstemmed | Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients |
| title_short | Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients |
| title_sort | management of bk virus associated haemorrhagic cystitis in allogeneic stem cell transplant recipients |
| url | https://doi.org/10.1177/2049936121991377 |
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