1560. Clinical Presentation of BK virus-associated hemorrhagic cystitis (HC) after hematopoietic cell transplantation (HCT)
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • BK_poster2.pdf (656.0 kB)
  • Background: BK polyoma virus (BKPyV) has been associated with hemorrhagic cystitis after HCT. Prior studies have examined risk factors for BKPyV-associated HC, but the characteristics of disease, including duration, common presentations, and the spectrum of clinical outcomes, have not been well described. Precise estimates of major clinical endpoints are critical to design clinical trials of novel prevention and treatment agents.

    Methods: We retrospectively analyzed HCT patients between 2007-2017. Subjects were included if they had macroscopic hematuria (Bedi grade ≥2), a positive urine BKPyV PCR, and at least one plasma BKPyV viral load available after platelet engraftment or day 28 post-HCT. HC was defined by hematuria and positive urine BKPyV PCR; duration was determined by time to resolution of hematuria. Demographic data, baseline symptoms, and clinical outcomes (e.g. need for bladder irrigation, use of cidofovir) were reviewed.

    Results: BKPyV-HC developed in 149 HCT recipients (97.3% allogeneic, 73% myeloablative conditioning) at a median of 54 days post-transplant (IQR 40 – 73). 7% were co-infected with adenovirus at the time of diagnosis. Symptoms and outcomes are shown in Table 1. Of those with plasma viral load testing at the onset of HC, 91% (112/126) had BKPyV viremia with a median viral load of 2200 copies/mL (IQR 385 – 9300). 29% of the cohort received cidofovir.

    Conclusion: We describe the characteristics of BKPyV-associated HC in HCT recipients in the modern era of immunosuppression. BKPyV-associated HC is a morbid disease in need of improved management strategies; patient-centered estimates of outcomes are crucial for evaluating new agents.

    Table 1. Symptoms and outcomes of BKPyV-associated HC

    BKPyV- HC

    n=149 (%)

    Clots in urine*

    92 (60)

    Dysuria*

    124 (81)

    Frequency*

    91 (59)

    Urgency*

    68 (44)

    Flank pain*

    22 (14)

    Abdominal pain*

    30 (20)

    Median duration of symptoms in days (IQR)

    25 (14 – 49)

    Median duration of hematuria or urine clots in days (IQR)

    18 (12 – 39)

    Median duration of phenazopyridine or oxybutynin use in days (IQR)

    19 (8 – 34.5)

    Need for pain medication

    109 (71)

    Need for Foley placement

    49 (32)

    Need for continuous bladder irrigation

    26 (17)

    Need for surgical intervention

    9 (6)

    *At presentation

    Any time during course

    Hannah Imlay, MD1, Hu Xie, MSc2, Wendy Leisenring, ScD2, Louise Kimball, PhD3, Steven Pergam, MD, MPH, FIDSA3, Ajit Limaye, MD, FIDSA4 and Michael Boeckh, MD, PhD, FIDSA3, (1)Infectious Disease, University of Washington, Seattle, WA, (2)Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, (3)Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, (4)Medicine, University of Washington, Seattle, WA

    Disclosures:

    H. Imlay, None

    H. Xie, None

    W. Leisenring, None

    L. Kimball, None

    S. Pergam, Merck: Consultant , Consulting fee . Chimerix: Consultant , Consulting fee .

    A. Limaye, Novartis: Consultant , Consulting fee .

    M. Boeckh, Vir Biotechnology: Consultant and Grant Investigator , Consulting fee and Research grant . Chimerix Inc: Consultant , Grant Investigator and Investigator , Consulting fee , Research grant and Research support .

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.