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Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients

BK virus (BKV)-related haemorrhagic cystitis (HC) is an important cause of morbidity following allogeneic haematopoietic stem cell transplantation (HSCT). The various risk factors include high-level BKV viruria and/or viremia, myeloablative conditioning, acute graft versus host disease (GVHD), cytom...

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Autores principales: Jandial, Aditya, Mishra, Kundan, Sandal, Rajeev, Kant Sahu, Kamal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871057/
https://www.ncbi.nlm.nih.gov/pubmed/33614030
http://dx.doi.org/10.1177/2049936121991377
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author Jandial, Aditya
Mishra, Kundan
Sandal, Rajeev
Kant Sahu, Kamal
author_facet Jandial, Aditya
Mishra, Kundan
Sandal, Rajeev
Kant Sahu, Kamal
author_sort Jandial, Aditya
collection PubMed
description BK virus (BKV)-related haemorrhagic cystitis (HC) is an important cause of morbidity following allogeneic haematopoietic stem cell transplantation (HSCT). The various risk factors include high-level BKV viruria and/or viremia, myeloablative conditioning, acute graft versus host disease (GVHD), cytomegalovirus viremia, and unrelated or HLA-mismatched donor. The presence of high plasma BK viral load and cytopenias have been implicated as important predictors for protracted disease course. These patients frequently require hospitalisation which may extend for several weeks. Supportive measures in the form of analgesics, intravenous hydration, bladder irrigation, and transfusion support remain the mainstay of management. Various drugs have been used with limited success in this setting. These include antiviral drugs, fluoroquinolones, leflunomide, growth factors, clotting factors, estrogens, and prostaglandins. The role of adoptive cellular immunotherapy has also been explored but lacks clinical validation. The strategies aimed at expediting urothelial repair like hyperbaric oxygen therapy (HBOT), intravesical fibrin glue and platelet-rich plasma (PRP) are emerging. Some patients with severe disease do require surgical intervention to relieve urinary obstruction. The frequent co-occurrence of acute GVHD and CMV disease further complicates the management in such patients. There is an unmet need for effective and evidence-based options for the prevention and management of this disease. Due to lack of robust data supported by randomised trials, the acceptability of the available guidelines to simplify the treatment is expected to be low. Despite the availability of various treatment options, the management of BKV-related HC in day-to-day practice continues to be a challenge. The aim of this article is to put forward an up-to-date review of the preventive and therapeutic strategies for BKV-related HC.
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spelling pubmed-78710572021-02-19 Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients Jandial, Aditya Mishra, Kundan Sandal, Rajeev Kant Sahu, Kamal Ther Adv Infect Dis Review BK virus (BKV)-related haemorrhagic cystitis (HC) is an important cause of morbidity following allogeneic haematopoietic stem cell transplantation (HSCT). The various risk factors include high-level BKV viruria and/or viremia, myeloablative conditioning, acute graft versus host disease (GVHD), cytomegalovirus viremia, and unrelated or HLA-mismatched donor. The presence of high plasma BK viral load and cytopenias have been implicated as important predictors for protracted disease course. These patients frequently require hospitalisation which may extend for several weeks. Supportive measures in the form of analgesics, intravenous hydration, bladder irrigation, and transfusion support remain the mainstay of management. Various drugs have been used with limited success in this setting. These include antiviral drugs, fluoroquinolones, leflunomide, growth factors, clotting factors, estrogens, and prostaglandins. The role of adoptive cellular immunotherapy has also been explored but lacks clinical validation. The strategies aimed at expediting urothelial repair like hyperbaric oxygen therapy (HBOT), intravesical fibrin glue and platelet-rich plasma (PRP) are emerging. Some patients with severe disease do require surgical intervention to relieve urinary obstruction. The frequent co-occurrence of acute GVHD and CMV disease further complicates the management in such patients. There is an unmet need for effective and evidence-based options for the prevention and management of this disease. Due to lack of robust data supported by randomised trials, the acceptability of the available guidelines to simplify the treatment is expected to be low. Despite the availability of various treatment options, the management of BKV-related HC in day-to-day practice continues to be a challenge. The aim of this article is to put forward an up-to-date review of the preventive and therapeutic strategies for BKV-related HC. SAGE Publications 2021-02-03 /pmc/articles/PMC7871057/ /pubmed/33614030 http://dx.doi.org/10.1177/2049936121991377 Text en © The Author(s), 2021 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Review
Jandial, Aditya
Mishra, Kundan
Sandal, Rajeev
Kant Sahu, Kamal
Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients
title Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients
title_full Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients
title_fullStr Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients
title_full_unstemmed Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients
title_short Management of BK virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients
title_sort management of bk virus-associated haemorrhagic cystitis in allogeneic stem cell transplant recipients
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871057/
https://www.ncbi.nlm.nih.gov/pubmed/33614030
http://dx.doi.org/10.1177/2049936121991377
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