Methods: We performed a retrospective review of HSCT patients at TCH diagnosed with HC from 1/1/11 to 12/31/14.
Results: Forty HSCT patients developed BKV-HC during the study period. The mean age was 10.9 years (2.1 – 20 years). Twenty-nine (72.5%) were male. Thirty-eight (95%) underwent allogenic HSCT (underlying diagnoses: leukemia (19), aplastic anemia/ myelodysplastic syndrome (9), primary immunodeficiency (4), hemoglobinopathy (3), lymphoma (2), and adrenoleukodystrophy). Two underwent autologous HSCT for high-risk neuroblastoma.
BKV-HC occurred an average of 75 days after transplant (range 0-1222 days). The mean duration of HC was 175 days (2-1305 days). Patients required a total of 54 admissions for HC (0-4 admissions/ patient). Mean peak serum creatinine associated with HC was 3.7 times baseline (range 1-14.7 times baseline). Seventeen patients had HC grade 4; 13 had HC grade 3. Seventeen patients (42.5%) required Foley placement to relieve urinary obstruction, 13 (32.5%) required continuous bladder irrigation and 6 (15%) required nephrostomy tubes. All cause mortality for patients with BKV-HC was 37.5%.
The peak in creatinine above baseline was associated with duration of viremia (p=0.03) but not viruria. Likewise HC grades 3-4 were associated with peak viremia > 10,000 (p=0.02) but not peak viruria.
Thirty-nine patients (98%) received fluoroquinolone (FQ) therapy, 15 (37.5%) received intravenous (IV) cidofovir, 13 (32.5%) received intravesicular cidofovir, and 5 (12.5%) received virus specific cytotoxic T-lymphocytes (CTLs). For patients with grade 3-4 HC who survived > 6 weeks after BKV-HC diagnosis, 6/21 (29%) had a partial or complete response to FQ, 7/9 (78%) to IV cidofovir, 8/11 (73%) to intravesicular cidofovir, and 4/4 (100%) to CTLs.
Conclusion: Pediatric HSCT patients who develop BKV-HC experience significant morbidity. Peak and duration of viremia is associated with clinical outcome. Cidofovir therapy is associated with clinical response. New therapeutic modalities such as virus-specific CTLs might be a promising new intervention for pediatric HSCT patients with BKV-HC.
A. Seth, None
S. Naik, None
C. E. Bocchini, None
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