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Intravesical cidofovir application in BK virus cystitis after allogeneic hematopoetic stem cell transplantation (HSCT) is safe and highly effective

Bone Marrow Transplantation volume 53, pages 495–498 (2018)Cite this article

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BK polyoma virus (BKPyV) is a double stranded DNA polyomavirus colonizing the urinary tract in early life [1]. BKPyV seroprevalence of is about 90%, however clinical manifestations is only seen in immuno-suppressed individuals (e.g., solid-organ transplant recipients) [2]. Virus reactivation may lead to hemorrhagic cystitis (HC) in hematopoietic stem cell transplantation (HSCT) causing significant morbidity [3]. BKPyV cystitis typically occurs early upon HSCT in approximately 13% (5–25%) of patients [3, 4]. Symptoms vary widely from mild dysuria, painless hematuria to painful hematuria or even severe HC with intravesical clotting and urethral obstruction and potential secondary renal failure [3, 5].

No standard treatment of BKPyV cystitis exists. Reducing immunosuppression is recommended in the absence of co-existing graft versus host disease (GvHD). There's no licensed antiviral medication for BKPyV, but many case series evaluated intravenous (i.v.) cidofovir in BKPyV infection after HSCT, with response ranging from 47 to 88% [6, 7]. However, i.v. cidofovir induces substantial renal toxicity [7], which is a major issue in HSCT setting. As an alternative, intravesical may substitute i.v. application by limiting local BKPyV replication while minimizing systemic side effects. In line with this idea, case reports and small case series reported efficacy of this approach [8, 9].

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Authors and Affiliations

  1. Medical Clinic III for Oncology, Hematology, Immunoncology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany

    Karin Mayer, Martin Schumacher, Peter Brossart & Dominik Wolf

  2. Institute of Virology, University Hospital Bonn (UKB), Bonn, Germany

    Anna M. Eis-Hübinger, Sandra Pietzonka & Christian Drosten

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  1. Karin Mayer
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Correspondence to Karin Mayer.

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Mayer, K., Schumacher, M., Eis-Hübinger, A.M. et al. Intravesical cidofovir application in BK virus cystitis after allogeneic hematopoetic stem cell transplantation (HSCT) is safe and highly effective. Bone Marrow Transplant 53, 495–498 (2018). https://doi.org/10.1038/s41409-017-0044-x

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