• Simone Cesaro, Hans H Hirsch, Maura Faraci, Joanna Owoc-Lempach, Angela Beltrame, Andrea Tendas, Ioannis Baltadakis, Jean-Hughes Dalle, Yener Koc, Jacek Toporski, Jan Styczynski, M Akif Yesilipek, Werner Heinz, Maurizio Caniglia, Jelena Rascon, Axel A Fauser, Mauricette Michallet, Lucia Lopez-Corral, Stefan Neuburger, Gloria Tridello, Herman Einsele, and European Group for Blood and Marrow Transplantation.
• University of Padua, Padua, Italy.
• Clin. Infect. Dis. 2009 Jul 15; 49 (2): 233-40.

BackgroundBK virus-associated hemorrhagic cystitis (BKV-HC) is a severe complication after allogeneic hematopoietic stem cell transplantation (HSCT), but antiviral treatment for this condition has not been evaluated.MethodsWe conducted a retrospective survey on the safety and outcome of cidofovir treatment for patients with BKV-HC in centers affiliated with the European Group for Blood and Marrow Transplantation.ResultsFrom 1 April 2004 to 31 December 2007, 62 patients received a diagnosis of BKV-HC after a median interval of 35 days after HSCT (range, 3-577 days). Fifty-seven patients (92%) received intravenous cidofovir, whereas 5 patients received cidofovir intravesically. Complete response (CR) was recorded in 38 (67%) of 57 patients with HC treated with intravenous cidofovir, whereas partial response (PR) was documented in 7 patients (12%). CR was documented in 3 patients and PR in 1 patient with HC treated with intravesical cidofovir. A reduction of 1-3 logs in BKV load was documented in 8 of the 10 patients achieving CR. Mild-to-moderate toxic effects were recorded in 18 of 57 patients who received intravenous cidofovir administration. In a multivariate analysis, the factors significantly associated with response to cidofovir were the stem cell source (P = .01) and the use of total body irradiation (P = .03). After a median follow-up of 287 days, overall survival and total treatment-related mortality rates were 63% and 40% for patients achieving CR, compared with 14% and 72% for patients with PR or no response to cidofovir, respectively (P = .001 and P = .001, respectively).ConclusionsCidofovir may be a potentially effective therapy for BKV-HC, but evidence supporting its use requires randomized controlled trials.

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