BK Virus-Hemorrhagic Cystitis Following Allogeneic Stem Cell Transplantation: Clinical Characteristics and Utility of Leflunomide TreatmentYoung Hoon Park, Joo Han Lim, Hyeon Gyu Yi, Moon Hee Lee, Chul Soo KimInha University Faculty of Medicine and Hospital, Department of Hematology-Oncology, Incheon, Republic of Korea
Objective: BK virus-hemorrhagic cystitis (BKV-HC) is a potential cause of morbidity and mortality in patients having undergone allogeneic stem cell transplantation (Allo-SCT). We analyzed the clinical features of BKV-HC following Allo-SCT and reported the utility of leflunomide
therapy for BKV-HC.
Materials and Methods: From January 2005 to June 2014, among the 69 patients that underwent Allo-SCT in our institution, the patients who experienced BKV-HC were investigated retrospectively.
Results: HC was observed in 30 patients (43.5%), and among them, 18 of the cases (26.1%) were identified as BKV-HC. The median age of the patients (12 males and 6 females) was 45 years (minimum-maximum: 13-63). Patients received Allo-SCT for acute myeloid leukemia (n=11), aplastic anemia (n=4), myelodysplastic syndrome (n=2), and non-Hodgkin lymphoma (n=1). The donor types were human leukocyte antigen (HLA)-matched sibling donor for six patients, HLA-matched unrelated donor for nine, and haploidentical familial donor for two. The median onset and duration of BKV-HC was on day 21 after transplantation (minimum-maximum: 7-97) and 22 days (minimum-maximum: 6-107). Eleven patients (62.1%) had grade I-II HC and seven patients (38.9%) had grade III-IV (high-grade) HC. Among the seven patients who had high-grade HC, one had complete response, one had partial response, and five had no response. Among the five nonresponders, one died of BKV-HC associated complications. The remaining four patients were treated with leflunomide, achieving complete response (n=2) and partial response (n=2). The median duration from the start of leflunomide therapy to response was 13 days (minimum-maximum: 8-17 days). All patients tolerated the leflunomide treatment well, with three patients having mild gastrointestinal symptoms, including anorexia and abdominal bloating.
Conclusion: BKV-HC was commonly observed in patients with HC following Allo-SCT. In high-grade BKV-HC patients who do not respond to supportive care, leflunomide may be a feasible option without significant toxicity.
Keywords: BK virus, Hemorrhagic cystitis, Allogeneic stem cell transplantation, Leflunomide
Allojenik Kök Hücre Transplantasyonu Sonrası BK Virüs Hemorajik Sistiti: Klinik Özellikleri ve Leflunomid Tedavisinin EtkisiYoung Hoon Park, Joo Han Lim, Hyeon Gyu Yi, Moon Hee Lee, Chul Soo KimInha University Faculty of Medicine and Hospital, Department of Hematology-Oncology, Incheon, Republic of Korea
Amaç: BK-virüs hemorajik sistiti (BKV-HS) allojenik kök hücre nakli (Allo-KHN) uygulanan hastalarda morbidite ve mortalitenin önemli bir nedenidir. Bu çalışmada Allo-KHN sonrası BKV-HS olan olguların klinik özellikleri ve leflunomid tedavisinin BKV-HS’deki etkinliği araştırılmıştır.
Gereç ve Yöntem: Kliniğimizde Ocak 2005-Haziran 2014 arası Allo- KHN uygulanmış 69 hastada, BKV-HS geçirmiş olanlar retrospektif olarak değerlendirildi.
Bulgular: Otuz hastada (%43,5) HS gözlendi. Bu olguların 18’inde (%26,1) BKV-HS’si saptandı. Hastaların (12’si erkek, altısı kadın) medyan yaşı 45 (13-63) idi. Hastalara akut miyeloid lösemi (n=11), aplastik anemi (n=4), miyelodisplastik sendrom (n=2) ve non-Hodgkin lenfoma (n=1) nedeni ile Allo-KHN uygulanmıştı. Altısında insan lökosit antijeni (İLA)-uygun kardeş, dokuzunda İLA-uygun akraba dışı donör ve ikisinde haplo-identik donör kullanılmıştı. Transplant sonrası BKV-HS medyan başlangıç zamanı 21 gün (7-97 gün), medyan süresi 22 gün (6-107 gün) idi. On bir olguda (%62,1) derece I-II, yedi olguda (%38,9) derece III-IV (yüksek derecede) HS saptandı. Yüksek derece HS’li yedi hastanın, birinde tam yanıt, birinde kısmi yanıt elde edilirken, beş hastada yanıt alınamadı. Yanıt alınmayan beş hastanın birisi BKV-HS ilişkili komplikasyonlardan kaybedildi. Geri kalan dört hasta leflunomid ile tedavi edildi. Bu hastaların ikisinde tam yanıt, ikisinde kısmi yanıt elde edildi. Leflunomidin başlangıcından itibaren medyan yanıt süresi 13 gündü (8-17 gün). Tüm hastalar leflunomidi iyi tolere ederken, üç hastada anoreksi ve abdominal gaz şikayetleri dahil hafif şiddetli gastrointestinal yan etkiler gözlendi.
Sonuç: Allo-KHN sonrası izlemde BKV-HS yaygın olarak gözlenmiştir. Destek tedavisine yanıt vermeyen yüksek derece BKV-HS’li olgularda leflunomid, anlamlı toksisitesi olmaksızın bir seçenek olabilir.
Anahtar Kelimeler: BK virüs, Hemorajik sistit, Allojenik kök hücre transplantasyonu, Leflunomid
Young Hoon Park, Joo Han Lim, Hyeon Gyu Yi, Moon Hee Lee, Chul Soo Kim. BK Virus-Hemorrhagic Cystitis Following Allogeneic Stem Cell Transplantation: Clinical Characteristics and Utility of Leflunomide Treatment. Turk J Hematol. 2016; 33(3): 223-230
Corresponding Author: Chul Soo Kim, Japan |
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