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Cidofovir in the Treatment of BK Virus-Associated Hemorrhagic Cystitis after Allogeneic Hematopoietic Stem Cell Transplantation.
- Source :
-
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2016 Apr; Vol. 22 (4), pp. 723-730. Date of Electronic Publication: 2015 Dec 21. - Publication Year :
- 2016
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Abstract
- After allogeneic hematopoietic stem cell transplantation (HSCT), BK virus-associated hemorrhagic cystitis (BKV-HC) is a common complication. Although supportive measures have been the standard of care for many years, several studies suggested the efficacy of cidofovir. The aim of this study was to assess the safety profile and efficacy of cidofovir. A retrospective study was conducted on all patients treated with cidofovir in our HSCT unit between March 2011 and May 2013. Data for efficacy (partial [PR] or complete response [CR]), prescription (dose, frequency, number of doses, and administration route), and toxicity were collected from published reports and medical files. Renal toxicity was evaluated using creatinine clearance calculated with the Cockcroft and Gault formula. A parallel literature search using PubMed (last search, May 2015) was performed. From March 2011 to June 2013, 27 of 181 patients undergoing allogeneic HSCT in our department received cidofovir for BKV-HC: 24 (88.9%) intravenously, 1 intravesically, and 2 via both routes. Mean dose was 5 mg/kg per administration, for a median of 4 injections (range, 1 to 11), from twice a week to once every 2 weeks. CR was achieved in 22 patients (81.5%), PR in 2, and no response in 2 patients. Eight patients presented renal failure (29.6%): 6 moderate (creatinine clearance < 60 mL/min) and 2 severe (creatinine clearance < 30 mLmin). Mean decrease in creatinine clearance after cidofovir was 27% (35 mL/min; range, 2 to 159). In 3 cases renal insufficiency and hematologic toxicity led to discontinuation of treatment or switch to intravesical instillation. For 3 patients cidofovir dose was reduced because of nephrotoxicity. Thirteen studies have reported on the use of cidofovir for BKV-HC (204 patients) since 2005. Intravenous cidofovir was used for 91.3% of patients, with doses ranging from .5 to 5 mg/kg. The main toxicity reported was renal failure (9% to 50% in 9 studies). Between 60% and 100% of CRs were observed independently of cidofovir dose or administration route. Cidofovir is an effective therapy for BKV-HC but requires very precise renal function management to avoid toxicity. Cidofovir treatment modalities (high dose, intravesical instillation, or low dose [≤1 mg/kg]) needs to be investigated in randomized controlled trials.<br /> (Copyright © 2016 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
BK Virus drug effects
BK Virus physiology
Cidofovir
Cystitis etiology
Cystitis immunology
Cystitis mortality
Cytosine therapeutic use
Drug Administration Schedule
Female
Glomerular Filtration Rate
Graft Survival
Hematologic Neoplasms immunology
Hematologic Neoplasms mortality
Hematologic Neoplasms pathology
Hematopoietic Stem Cell Transplantation adverse effects
Hematopoietic Stem Cell Transplantation methods
Hemorrhage etiology
Hemorrhage immunology
Hemorrhage mortality
Humans
Male
Middle Aged
Myeloablative Agonists therapeutic use
Polyomavirus Infections etiology
Polyomavirus Infections immunology
Polyomavirus Infections mortality
Retrospective Studies
Survival Analysis
Transplantation Conditioning
Transplantation, Homologous
Tumor Virus Infections etiology
Tumor Virus Infections immunology
Tumor Virus Infections mortality
Viral Load drug effects
Antiviral Agents therapeutic use
Cystitis therapy
Cytosine analogs & derivatives
Hematologic Neoplasms therapy
Hemorrhage therapy
Organophosphonates therapeutic use
Polyomavirus Infections therapy
Tumor Virus Infections therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6536
- Volume :
- 22
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 26718666
- Full Text :
- https://doi.org/10.1016/j.bbmt.2015.12.009