Details

Autor(en) / Beteiligte

• Neto, Nádia Sofia Machado

Titel

Polyomavirus BK Viruria and Viremia in Hematopoietic Stem Cell Transplantation

Ort / Verlag

ProQuest Dissertations & Theses

Erscheinungsjahr

2016

Link zum Volltext

• ProQuest

Quelle

ProQuest Dissertations & Theses A&I

Beschreibungen/Notizen

• Polyomavírus BK (BKV) infection affects 50-100% of patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT). Haemorrhagic cystitis (HC) is one of the most frequent complications in this type of patients, and it is associated with high morbidity.In order to analyse some features of BKV-associated HC in HSCT we have developed two independent studies: 1) a retrospective hospital-based study with urine samples from 158 patients undergoing allogeneic transplant between 2009 and 2013; and 2) a prospective study using blood and urine samples from 21 patients submitted to allogeneic transplant between November 2014 and March 2015.Regarding the retrospective study, we observed that amongst 158 patients, 73.4% developed BKV infection. This study revealed that BKV infection was significantly less prevalent in patients with >38 years old (p=0.003; OR=0.33; 95%IC 0.15-0.69) and more frequent in patients with mismatched or unrelated donors (p=0.006; OR=2.87; 95%IC 1.34- 6.18). The analysis also showed that BKV infection was significantly more frequent in patients that developed acute GVHD (p=0.019; OR=2.86; 95%IC 1.16-7.05) and with BKV coinfection with CMV (p=0.012; OR=2.51; 95%IC 1.22-5.20). The median time to infection was 30 days, the median duration of infection was 52 days with a median of 8.95 log copies/mL in urine. Of the patients included in this study, 20.9% developed HC, and of these 90.9% were BKV-associated HC (p=0.008, OR=4.59, 95%CI 1.32-15.95). This study also revealed that patients submitted to myeloablative regimen conditioning have a high risk for HC development (p=0.022, OR=2.94, 95%CI 1.13-7.64).Regarding the prospective study, we observed that 14.3% of patients developed HC, and these patients had a median of 2.71 log copies/mL in blood and of 7.36 log copies/mL in urine. This study also showed that viruria ≥4.11 log copies/mL was associated with HC development. The correlation between viruria ≥4.11 log copies/mL with clinical variables revealed that patients submitted to myeloablative regimen seem to have higher viral load than reduced intensity regimen (p=0.055).The BKV infection is common in patients undergoing allogeneic haematopoietic stem cell transplantation and the development of BKV-associated haemorrhagic cystitis is one of the comorbidities that affects these patients. However, there are no specific guidelines for the monitoring of BKV infection that should be addressed in the future.