• Leandro de Padua Silva, Poliana A Patah, Rima M Saliba, Nicholas A Szewczyk, Lisa Gilman, Joyce Neumann, Xiang-Yang Han, Jeffrey Tarrand, Rachel Ribeiro, Alison Gulbis, Elizabeth J Shpall, Roy Jones, Uday Popat, Julia A Walker, Demetrios Petropoulos, Alexandre Chiattone, John Stewart, Maha El-Zimaity, Paolo Anderlini, Sergio Giralt, Richard E Champlin, and Marcos de Lima.
• Department of Stem Cell Transplantation & Cell Therapy, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA.
• Haematologica. 2010 Jul 1; 95 (7): 1183-90.

BackgroundHemorrhagic cystitis is a common cause of morbidity after allogeneic stem cell transplantation, frequently associated with BK virus infection. We hypothesized that patients with positive BK viruria before unrelated or mismatched related donor allogeneic hematopoietic stem cell transplantation have a higher incidence of hemorrhagic cystitis.Design And MethodsTo test this hypothesis, we prospectively studied 209 patients (median age 49 years, range 19-71) with hematologic malignancies who received bone marrow (n=78), peripheral blood (n=108) or umbilical cord blood (n=23) allogeneic hematopoietic stem cell transplantation after myeloablative (n=110) or reduced intensity conditioning (n=99). Donors were unrelated (n=201) or haploidentical related (n=8).ResultsTwenty-five patients developed hemorrhagic cystitis. Pre-transplant BK viruria detected by quantitative PCR was positive in 96 patients. The one-year cumulative incidence of hemorrhagic cystitis was 16% in the PCR-positive group versus 9% in the PCR-negative group (P=0.1). The use of umbilical cord blood or a haploidentical donor was the only significant predictor of the incidence of hemorrhagic cystitis on univariate analysis. There was also a trend for a higher incidence after myeloablative conditioning. Multivariate analysis showed that patients who had a positive PCR pre-transplant and received haploidentical or cord blood grafts with myeloablative conditioning had a significantly higher risk of developing hemorrhagic cystitis (58%) than all other recipients (7%, P<0.001).ConclusionsHemorrhagic cystitis is the result of a complex interaction of donor type, preparative regimen intensity, and BK viruria.

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