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

Livio Pagano, Simone Cesaro, Tina Dalianis, Christine Hanssen Rinaldo, Minna Koskenvuo, Anna Pegoraro, Hermann Einsele, Catherine Cordonnier, Hans H. Hirsch, Murat Akova, Mahmoud Aljurf, Dina Averbuch, Rosemary Barnes, Ola Blennow, Pierre-Yves Bochud, Emilio Bouza, Stephane Bretagne, Roger Brüggemann, Thierry Calandra, Jordi CarratalaOliver Cornely, Rafael De La Camara, Peter Donnelly, Lubos Drgona, Rafael Duarte, Dan Engelhard, Christopher Fox, Corrado Girmenia, Andreas Groll, Dag Heldal, Jannick Helweg-Larsen, Raoul Herbrecht, Elisabeth Johnson, Galina Klyasova, Katrien Lagrou, Russell E. Lewis, Per Ljungman, Johan Maertens, Malgorzata Mikulska, Marcio Nucci, Christophe Padoin, Antonio Pagliuca, Zdenek Racil, Patricia Ribaud, Valérie Rizzi-Puechal, Emmanuel Roilides, Christine Robin, Montserrat Rovira, Markus Rupp, Sonia Sanchez, Peter Schellongowski, Peter Sedlacek, Janos Sinko, Monica Slavin, Isabella Sousa Ferreira, Jan Styczynski, Frederic Tissot, Claudio Viscoli, Katherine Ward, Anne-Therese Witschi

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Objectives: To define guidelines for BK polyomavirus (BKPyV)-associated haemorrhagic cystitis (BKPyV-HC) after paediatric and adult HSCT. Methods: Review of English literature and evidence-based recommendations by expert consensus. Results: 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 log10copies/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. Conclusions: BKPyV-HC remains a disabling unmet clinical need in HSCT that requires novel approaches supported by proper clinical trials.
Original languageEnglish
Pages (from-to)12-21
Number of pages10
JournalJournal of Antimicrobial Chemotherapy
Volume73
DOIs
Publication statusPublished - 2018

Keywords

  • Infectious Diseases
  • Pharmacology
  • Pharmacology (medical)

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