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Post-Transplant Events

A prospective study of BK-virus-associated haemorrhagic cystitis in paediatric patients undergoing allogeneic haematopoietic stem cell transplantation

Bone Marrow Transplantation volume 41, pages 363–370 (2008)Cite this article

Abstract

We investigated the incidence, risk factors and outcome of haemorrhagic cystitis (HC) in paediatric patients undergoing HSCT and the predictive value of BK viruria and viraemia for developing HC. Over a period of 54 months, 74 patients were recruited. The cumulative incidence of HC was 22%. Among 15 patients prospectively monitored for BK viruria and viraemia, four patients developed HC of grade ⩾II. This group, which had two consecutive BK positive samples, showed a sensitivity of 100%, a specificity of 82%, a positive predictive value of 67%, and negative predictive value of 100% for developing HC. Analysed by a receiver–operator characteristic curve (ROC), a urine BK load >9 × 106 genomic copies/ml had a sensitivity of 95% and specificity of 90%; while a blood BK load >1 × 103 genomic copies/ml had a sensitivity of 40% and a specificity of 93% for HC, respectively. In univariate analysis, BK positivity was the only factor significantly associated with HC. After a median follow-up of 1.8 years, patients with HC showed a lower overall survival, 40 vs 65%, P 0.01, and a lower event-free survival, 42 vs 62%, P 0.03, compared to patients without HC. We conclude that BK detection in urine and/or plasma is a specific predictor for developing HC.

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Acknowledgements

This study has been supported in part by a grant from the ‘Associazione Italiana per la Lotta contro le Leucemie, Linfomi, e Mieloma- Sezione di Trento’ to SC. We thank Stefania Gallo for her skilful assistance in editing the manuscript; Judith Kingston, MD, for the useful comments and review of the English style; and all the medical and nursing staff of Pediatric Hematology for the collaboration and dedication to our patients.

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Authors and Affiliations

  1. Department of Pediatrics, Pediatric Hematology Oncology, University of Padova, Padova, Italy

    S Cesaro, G Tridello, C Messina, E Calore, M Pillon, S Varotto & A Brugiolo

  2. Department of Pediatrics, Infectious Diseases of Pediatric Immunocompromised Host, University of Padova, Padova, Italy

    C Facchin

  3. Department of Histology, Microbiology and Medical Biotechnology, University of Padova, Padova, Italy

    M A Biasolo, C Mengoli & G Palù

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  1. S Cesaro
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Correspondence to S Cesaro.

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Cesaro, S., Facchin, C., Tridello, G. et al. A prospective study of BK-virus-associated haemorrhagic cystitis in paediatric patients undergoing allogeneic haematopoietic stem cell transplantation. Bone Marrow Transplant 41, 363–370 (2008). https://doi.org/10.1038/sj.bmt.1705909

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