154. BK Virus Epidemiology, Risk Factors & Outcomes: A Retrospective Analysis of Hematopoietic Stem Cell Transplant (HSCT) Patients at Texas Children’s Hospital (TCH)
Session: Poster Abstract Session: Big Viruses in Little People (Pediatric Viral Diseases)
Thursday, October 27, 2016
Room: Poster Hall
Background: BK virus associated hemorrhagic cystitis (BKV-HC) is a serious complication after pediatric HSCT. Limited data exist regarding the risk factors and treatment strategies for severe BKV-HC.

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.

Daniel Ruderfer, MD1, Jason Au, MD2, Abhishek Seth, MD2, Swati Naik, MD3 and Claire E. Bocchini, MD4, (1)Baylor College of Medicine and Texas Children's Hospital, Houston, TX, (2)Urology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, (3)Hematology-Oncology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, (4)Pediatrics, Section of Infectious Disease, Baylor College of Medicine and Texas Children's Hospital, Houston, TX


D. Ruderfer, None

J. Au, None

A. Seth, None

S. Naik, None

C. E. Bocchini, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.