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Juárez A, Salas MQ, Pedraza A, Suárez-Lledó M, Rodríguez-Lobato LG, Solano MT, Serrahima A, Nomdedeu M, Cid J, Lozano M, Charry P, Arcarons J, Llobet N, Rosiñol L, Fernández-Avilés F, Rovira M, Martínez C. Reduced Dose of Post-Transplant Cyclophosphamide with Tacrolimus for the Prevention of Graft-versus-Host Disease in HLA-Matched Donor Peripheral Blood Stem Cell Transplants: A Prospective Pilot Study. Cancers (Basel) 2024; 16:2567. [PMID: 39061206 PMCID: PMC11274764 DOI: 10.3390/cancers16142567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/03/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
PTCY 50 mg/kg/day on days +3/+4 is an excellent strategy to prevent GVHD. However, its use is associated with adverse outcomes such as delayed engraftment, increased risk of infection, and cardiac complications. This pilot study evaluates the efficacy and toxicity of a reduced dose of PTCY (40 mg/kg/day) combined with tacrolimus in 22 peripheral blood HLA-matched alloHSCT patients. At day +100, the cumulative incidences of grade II-IV and III-IV acute GVHD were 18.2% and 4.5%, respectively. No grade IV acute GVHD or steroid-refractory disease was observed. The cumulative incidences of all-grade and moderate-severe chronic GVHD at 1-year were 11.4% and 6.4%, respectively. No patient died from transplant-related complications. Two-year OS and RFS were 77.1% and 58.3%, respectively. All patients engrafted, with neutrophil and platelet recovery occurring at a median of 15 (IQR 14-16) and 16 days (IQR 12-23), respectively. The cumulative incidences of bloodstream bacterial infections, polyomavirus BK hemorrhagic cystitis, HHV6 reactivation, CMV reactivation, and fungal infections were 13.6%, 9.1%, 9.1%, 4.6%, and 6%, respectively. Only one early cardiac event was observed. These results suggest that PTCY 40 mg/kg/day on a +3/+4 schedule provides adequate immunosuppression to allow for engraftment and prevent clinically significant GVHD with a low toxicity profile.
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Affiliation(s)
- Alex Juárez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.J.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (M.T.S.); (A.S.); (J.A.); (N.L.); (L.R.); (F.F.-A.); (M.R.)
| | - María Queralt Salas
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.J.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (M.T.S.); (A.S.); (J.A.); (N.L.); (L.R.); (F.F.-A.); (M.R.)
| | - Alexandra Pedraza
- Hemotherapy and Hemostasis Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.P.); (M.N.)
| | - María Suárez-Lledó
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.J.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (M.T.S.); (A.S.); (J.A.); (N.L.); (L.R.); (F.F.-A.); (M.R.)
- August Pi i Sunyer Biomedical Research Institute—IDIBAPS, 08036 Barcelona, Spain; (J.C.); (M.L.); (P.C.)
| | - Luís Gerardo Rodríguez-Lobato
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.J.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (M.T.S.); (A.S.); (J.A.); (N.L.); (L.R.); (F.F.-A.); (M.R.)
- August Pi i Sunyer Biomedical Research Institute—IDIBAPS, 08036 Barcelona, Spain; (J.C.); (M.L.); (P.C.)
| | - María Teresa Solano
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.J.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (M.T.S.); (A.S.); (J.A.); (N.L.); (L.R.); (F.F.-A.); (M.R.)
| | - Anna Serrahima
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.J.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (M.T.S.); (A.S.); (J.A.); (N.L.); (L.R.); (F.F.-A.); (M.R.)
| | - Meritxell Nomdedeu
- Hemotherapy and Hemostasis Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.P.); (M.N.)
| | - Joan Cid
- August Pi i Sunyer Biomedical Research Institute—IDIBAPS, 08036 Barcelona, Spain; (J.C.); (M.L.); (P.C.)
- Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Miquel Lozano
- August Pi i Sunyer Biomedical Research Institute—IDIBAPS, 08036 Barcelona, Spain; (J.C.); (M.L.); (P.C.)
- Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Paola Charry
- August Pi i Sunyer Biomedical Research Institute—IDIBAPS, 08036 Barcelona, Spain; (J.C.); (M.L.); (P.C.)
- Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Jordi Arcarons
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.J.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (M.T.S.); (A.S.); (J.A.); (N.L.); (L.R.); (F.F.-A.); (M.R.)
| | - Noemí Llobet
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.J.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (M.T.S.); (A.S.); (J.A.); (N.L.); (L.R.); (F.F.-A.); (M.R.)
| | - Laura Rosiñol
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.J.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (M.T.S.); (A.S.); (J.A.); (N.L.); (L.R.); (F.F.-A.); (M.R.)
- August Pi i Sunyer Biomedical Research Institute—IDIBAPS, 08036 Barcelona, Spain; (J.C.); (M.L.); (P.C.)
- Institute Josep Carreras, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.J.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (M.T.S.); (A.S.); (J.A.); (N.L.); (L.R.); (F.F.-A.); (M.R.)
- August Pi i Sunyer Biomedical Research Institute—IDIBAPS, 08036 Barcelona, Spain; (J.C.); (M.L.); (P.C.)
- Institute Josep Carreras, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.J.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (M.T.S.); (A.S.); (J.A.); (N.L.); (L.R.); (F.F.-A.); (M.R.)
- August Pi i Sunyer Biomedical Research Institute—IDIBAPS, 08036 Barcelona, Spain; (J.C.); (M.L.); (P.C.)
- Institute Josep Carreras, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Institute of Cancer and Blood Disease (ICAMS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (A.J.); (M.Q.S.); (M.S.-L.); (L.G.R.-L.); (M.T.S.); (A.S.); (J.A.); (N.L.); (L.R.); (F.F.-A.); (M.R.)
- August Pi i Sunyer Biomedical Research Institute—IDIBAPS, 08036 Barcelona, Spain; (J.C.); (M.L.); (P.C.)
- Institute Josep Carreras, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
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Sayýn S, Yýldýrým M, Cömert M, Uğur B, Yýlmaz EŞ, Avcu F, Ural AU, Aylı M. Comparison of Infectious Complications in Patients Receiving High-Dose Cyclophosphamide as GvHD Prophylaxis After Transplantation From A 9/10 HLA-Matched Unrelated Donor with Standard GvHD Prophylaxis After Transplant From A Fully Matched Related Donor. Mediterr J Hematol Infect Dis 2024; 16:e2024016. [PMID: 38468829 PMCID: PMC10927186 DOI: 10.4084/mjhid.2024.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/05/2024] [Indexed: 03/13/2024] Open
Abstract
Background The aim of this study was to evaluate whether cyclophosphamide administered after allogeneic stem cell transplantation (ASCT) from 9/10 HLA-Matched Unrelated Donors (MMUD) increases the rates of bacterial, fungal, viral infections, complications (hemorrhagic cystitis (HC)), and infection-related mortality compared to allogeneic stem cell transplantation from matched related donors (MRD). Methods This is a retrospective multicenter study. 45 MMUD ASCT patients who received posttransplant cyclophosphamide+methotrexate+calcineurin inhibitor compared with 45 MRD ASCT patients who received methotrexate+calcineurin inhibitor. Results Although there was a statistically significant prolongation of neutrophil engraftment time in the PTCy arm, there was no statistically significant difference in bacterial infection frequencies between the groups (PTCy; 9 (20%), control; 8 (17.8%), p=0.778). The distribution of CMV infection in the first 100 days was similar (p=0.827), but the distribution of CMV infection rate between the 100th and 365th days was observed more frequently in the control group (p=0.005). HC rates and their grades were similar in both groups (PTCy; 4 (8.8%), control; 6 (13.3%) p=0.502). The rates of VZV infection and invasive aspergillosis were similar in the PTCy and control groups (13.3% in the PTCy and 17.8% in the control group p=0.561). There is also no statistically significant difference in survival analysis (OS, LFS, GRFS, RI, IRM, NRM) between groups. However, the incidence of cGVHD was significantly higher in the control group (P=0.035). Conclusions The addition of PTCy to standard GvHD prophylaxis in MMUD ASCT does not lead to an increase in CMV reactivation, bacterial infections, invasive fungal infection, viral hemorrhagic cystitis, or mortality.
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Affiliation(s)
- Selim Sayýn
- Gülhane Education and Research Hospital, Department of Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Murat Yýldýrým
- Gülhane Education and Research Hospital, Department of Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Melda Cömert
- Gülhane Education and Research Hospital, Department of Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Bilge Uğur
- Gülhane Education and Research Hospital, Department of Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Esra Şafak Yýlmaz
- Gülhane Educational and Research Hospital, Department of Medical Informatics, Ankara, Turkey
| | - Ferit Avcu
- Ankara Memorial Hospital Department of Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Ali Uğur Ural
- Bayındır Sögütözü Hospital Department of Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Meltem Aylı
- Gülhane Education and Research Hospital, Department of Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
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Moss JE, Muller WJ. BK virus-associated hemorrhagic cystitis in pediatric stem cell transplantation: a case report and scoping review. Front Pediatr 2024; 11:1267678. [PMID: 38406625 PMCID: PMC10884191 DOI: 10.3389/fped.2023.1267678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/29/2023] [Indexed: 02/27/2024] Open
Abstract
Introduction BK virus-associated hemorrhagic cystitis (BK-HC) is a debilitating and poorly understood complication of hematopoietic stem cell transplantation (SCT). Hematuria, dysuria, and other symptoms associated with BK-HC are common in the immediate post-SCT period, making BK-HC difficult to distinguish from other conditions presenting with these symptoms. Despite published criteria for diagnosis, the degree to which these criteria are consistently applied to either clinical diagnosis or to studies informing BK-HC management is unclear. We present a case of BK-HC in a pediatric SCT recipient, and discuss the challenges associated with treatment in the absence of rigorous data to inform clinical management. Methods We reviewed all cases of BK viruria at our center in patients undergoing SCT between January 2015 and December 2019. We then performed a scoping review of publications in PubMed addressing BK-HC, specifically focusing on how BK-HC was defined. Publications using the keywords "BK polyomavirus" and "hemorrhagic cystitis" were included if they involved a clinical study of SCT recipients and a full-text article was available in English. Case reports were excluded. Analysis focused on whether BK-HC was explicitly defined and whether the definition incorporated elements of diagnostic criteria published by European Conference on Infections in Leukemia (ECIL). Results A total of 30 studies published between January 2018 and 30 June 2021 met criteria for review, including 4 clinical trials, 7 prospective observational studies, and 19 retrospective observational studies. Fifteen of these studies included pediatric patients (7 pediatric only, 8 combined adult and pediatric). Of the 30 publications, 19 included a definition of either BK-HC or BK cystitis, with only five using ECIL criteria, all of which were observational studies. Multiple interventions are described for treatment of BK-HC, including cidofovir, leflunomide, quinolones, hyperbaric oxygen, keratinocyte growth factor, and BK-specific cytotoxic T lymphocytes. However, evidence to support efficacy for any of these interventions is lacking. Discussion Although BK-HC is a well-known complication of SCT, evidence to support available treatment options is limited. Well-controlled studies that incorporate clear diagnostic criteria are needed to better define the risk factors, natural history, and ideal interventions.
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Affiliation(s)
- Julia E. Moss
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - William J. Muller
- Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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4
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Duléry R, Malard F, Brissot E, Banet A, Sestili S, Belhocine R, Calabro M, Van de Wyngaert Z, Bonnin A, Ledraa T, Legrand O, Labopin M, Capderou E, Cohen A, Ederhy S, Mohty M. Reduced post-transplant cyclophosphamide dose with antithymocyte globulin in peripheral blood stem cell haploidentical transplantation. Bone Marrow Transplant 2023; 58:1215-1222. [PMID: 37596473 DOI: 10.1038/s41409-023-02085-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023]
Abstract
Post-transplant cyclophosphamide (PT-Cy) is effective for graft-versus-host disease (GVHD) prophylaxis, but it may cause dose-dependent toxicities, particularly in frail patients. Therefore, we compared the outcomes with a reduced PT-Cy total dose (70 mg/kg) to those with the standard PT-Cy dose (100 mg/kg) in haploidentical hematopoietic cell transplantation (HCT) patients aged ≥ 65 years and those with cardiac comorbidities. All consecutive patients with a hematological malignancy receiving peripheral blood stem cells (PBSCs) after a thiotepa-based conditioning with low-dose antithymocyte globulin were included. Thirty-three patients received PT-Cy at 70 mg/kg and 25 at 100 mg/kg. PT-Cy dose reduction did not increase the risk of GVHD and was associated with faster neutrophil and platelet recovery, and lower cumulative incidences of bacteremia (38% versus 72%, p = 0.004) and cardiac complications (12% versus 44%, p = 0.028). At 2 years, GVHD-free, relapse-free survival (GRFS) was higher with the reduced dose compared to the standard dose (60% versus 33%, p = 0.04). In conclusion, reducing PT-Cy total dose to 70 mg/kg is a safe and valid approach for elderly patients and those with cardiac comorbidities underdoing haploidentical HCT with PBSCs and low-dose antithymocyte globulin. The reduced PT-Cy dose was associated with improved hematological count recovery, lower incidence of toxicities, and higher GRFS.
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Affiliation(s)
- Rémy Duléry
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
- INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France.
| | - Florent Malard
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Eolia Brissot
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Anne Banet
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Simona Sestili
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ramdane Belhocine
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Martina Calabro
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zoé Van de Wyngaert
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Agnès Bonnin
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tounes Ledraa
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ollivier Legrand
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France
| | - Myriam Labopin
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Acute Leukemia Working Party, European Society for Blood and Marrow Transplantation (EBMT) Paris Study Office/CEREST-TC, Paris, France
| | - Elodie Capderou
- Sorbonne University, UNICO-GRECO Cardio Oncology Program, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ariel Cohen
- Sorbonne University, UNICO-GRECO Cardio Oncology Program, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Ederhy
- Sorbonne University, UNICO-GRECO Cardio Oncology Program, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, UMRs 938, Centre de recherche Saint Antoine (CRSA), Paris, France
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5
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Zhou X, Zhang S, Fan J, Zhu X, Hu S. Risk factors for BK virus-associated hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation: A systematic review and meta-analysis. Clin Transplant 2023; 37:e15121. [PMID: 37676427 DOI: 10.1111/ctr.15121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE AND BACKGROUND BK virus-associated hemorrhagic cystitis (BKV-HC) is an intractable complication leading to higher mortality and prolonged hospitalization among allogeneic hematopoietic stem cell transplantation (allo-HCT) recipients. Therefore, identifying the potential risk factors of BKV-HC after allo-HCT is crucial to improve prognosis and for early prevention. However, the risk factors for BKV-HC remain debatable. Therefore, we conducted a systematic review and meta-analysis to identify the risk factors for BKV-HC, for early prevention of the occurrence of BKV-HC and to improve the quality of life and prognosis of allo-HCT recipients. METHODS We searched relevant studies from PubMed, EMBASE, and the Cochrane Library up to February 2023. The odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of all risk factors were calculated to evaluate their effects on the occurrence of BKV-HC. RESULTS Overall, 11 studies involving 2556 allo-HCT recipients were included in this meta-analysis. All included studies were retrospective and published between 2013 and 2022. We found that male sex (OR = 1.32; 95% CI, 1.07-1.62; p = .009, I2 = 34%), haploidentical donor (OR = 1.84; 95% CI, 1.18-2.87; p = .007, I2 = 23%), myeloablative conditioning (OR = 1.76; 95% CI, 1.36-2.28; p < .0001, I2 = 45%), acute graft versus host disease (aGVHD) (OR = 2.73; 95% CI, 2.02-3.69; p < .0001, I2 = 46%), chronic graft versus host disease (cGVHD) (OR = 1.71; 95% CI, 1.12-2.60; p = .01, I2 = 0%), and cytomegalovirus (CMV) reactivation (OR = 3.13; 95% CI, 1.12-8.78; p = .03, I2 = 79%) were significantly associated with BKV-HC in the univariable analysis. CONCLUSIONS Our meta-analysis indicated that male sex, haploidentical donor, myeloablative conditioning, aGVHD, cGVHD, and CMV reactivation were potential risk factors for BKV-HC.
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Affiliation(s)
- Xuemei Zhou
- Department of Hematology and Oncology, Children's Hospital of Soochow University, Suzhou, China
| | - Senlin Zhang
- Department of Hematology and Oncology, Children's Hospital of Soochow University, Suzhou, China
| | - Junjie Fan
- Department of Hematology and Oncology, Children's Hospital of Soochow University, Suzhou, China
| | - Xiaoping Zhu
- Department of Quality and Safety Control, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shaoyan Hu
- Department of Hematology and Oncology, Children's Hospital of Soochow University, Suzhou, China
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6
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Santos Carreira A, Salas MQ, Remberger M, Novitzky-Basso I, Law AD, Lam W, Pasic I, Mazzulli T, Cserti-Gazdewich C, Kim DDH, Michelis FV, Viswabandya A, Gerbitz A, Lipton JH, Kumar R, Hassan M, Mattsson J. Interaction Between High-Dose Intravenous Busulfan and Post-Transplantation Cyclophosphamide on Hemorrhagic Cystitis After Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2023; 29:581.e1-581.e8. [PMID: 37437765 DOI: 10.1016/j.jtct.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/10/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023]
Abstract
This study investigates the incidence and predictors of hemorrhagic cystitis (HC) in 960 adults undergoing allo- hematopoietic stem cell transplantation. Two hundred fifty-two (26.5%) patients received myeloablative conditioning regimens, and 81.4% received high-dose intravenous busulfan (HD Bu). Six hundred ninety-five (72.4%) patients received post-transplantation cyclophosphamide (PTCY)-based prophylaxis, and 91.4% additionally received anti-thymocyte globulin (ATG) and Cyclosporine A (CsA) (PTCY-ATG-CsA). Two hundred twenty-eight (23.8%) patients developed HC. The day 100 cumulative incidences of grades 2-4 and 3-4 HC were 11.1% and 4.9%. BK virus was isolated in 58.3% of urinary samples. Using HD BU myeloablative regimens increased the risk for grade 2-4 HC (hazard ratio [HR] = 1.97, P = .035), and HD BU combined with ATG-PTCY-CsA increased this 4 times (HR = 4.06, P < .001) for grade 2-4 HC compared to patients who received neither of these drugs. A significant correlation was documented between grade II-IV acute graft-versus-host disease and grade 2-4 HC (HR = 2.10, P < .001). Moreover, patients with BK-POS grade 2-4 HC had lower 1-year overall survival (HR = 1.51, P = .009) and higher non-relapse mortality (HR = 2.31, P < .001), and patients with BK-NEG grade 2-4 HC had comparable post-transplantation outcomes. In conclusion, intravenous HD Bu was identified as a predictor for grade 2-4 HC. Moreover, when HD Bu was combined with PTCY-ATG-CsA, the risk increased 4-fold. Based on the results provided by this study, preventing the onset of HC, especially in high-risk patients, is mandatory because its presence significantly increases the risk for mortality.
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Affiliation(s)
- Abel Santos Carreira
- University of Toronto, Department of Medicine, Section of Medical Oncology and Hematology, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Maria Queralt Salas
- University of Toronto, Department of Medicine, Section of Medical Oncology and Hematology, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Hematopoietic Cell Transplant Unit, Department of Hematology, IDIBAPS, Hospital Clinic de Barcelona, Spain
| | - Mats Remberger
- Department of Medical Sciences, Uppsala University and KFUE, Uppsala University Hospital, Uppsala, Sweden
| | | | - Arjun Datt Law
- University of Toronto, Department of Medicine, Section of Medical Oncology and Hematology, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Wilson Lam
- University of Toronto, Department of Medicine, Section of Medical Oncology and Hematology, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ivan Pasic
- University of Toronto, Department of Medicine, Section of Medical Oncology and Hematology, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tony Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Microbiology, Sinai Health System/University Health Network, Toronto, Ontario, Canada
| | - Christine Cserti-Gazdewich
- University of Toronto, Department of Medicine, Section of Medical Oncology and Hematology, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Blood Transfusion Laboratory, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Dennis Dong Hwan Kim
- University of Toronto, Department of Medicine, Section of Medical Oncology and Hematology, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Fotios V Michelis
- University of Toronto, Department of Medicine, Section of Medical Oncology and Hematology, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Auro Viswabandya
- University of Toronto, Department of Medicine, Section of Medical Oncology and Hematology, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Armin Gerbitz
- University of Toronto, Department of Medicine, Section of Medical Oncology and Hematology, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey Howard Lipton
- University of Toronto, Department of Medicine, Section of Medical Oncology and Hematology, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rajat Kumar
- University of Toronto, Department of Medicine, Section of Medical Oncology and Hematology, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Moustapha Hassan
- Translational Research Centrum (TRACK), Karolinska University Hospital, Huddinge, Sweden; Division of Biomolecular and Cellular Medicine (BCM), Department of Laboratory Medicine, Karolinska Institutet- Huddinge, Sweden
| | - Jonas Mattsson
- University of Toronto, Department of Medicine, Section of Medical Oncology and Hematology, Toronto, Ontario, Canada; Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
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7
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Xie XT, Zhang YF, Zhang Y, Zeng HQ, Deng JC, Zhou K, Chen L, Luo Y, Lou SF. Decreased lymphocyte count before conditioning is associated with BK virus-associated hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation. Int Immunopharmacol 2023; 121:110515. [PMID: 37379706 DOI: 10.1016/j.intimp.2023.110515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND BK virus-associated hemorrhagic cystitis (BKV-HC) is a serious complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). It can cause morbidity and may increase treatment-related mortality. Previous studies showed that the occurrence of BKV-HC was related to various factors. However, there are still many controversial factors. It is not clear whether BKV-HC will affect the long-term prognosis of patients. OBJECTIVE We aimed to identify risk factors for BKV-HC after allo-HSCT and evaluate the effect of BKV-HC on overall survival (OS) and progression- free survival (PFS) of patients. STUDY DESIGN We retrospectively analyzed the clinical data of 93 patients who underwent allo-HSCT. Univariate and multivariate analysis were used to identify risk factors for BKV-HC. The Kaplan-Meier method was used to estimate OS and PFS. A difference was considered statistically significant if P < 0.05. RESULTS A total of 24 patients developed BKV-HC. The median occurrence time of BKV-HC was 30 (range:8-89) days after transplantation, and the median duration was 25.5 (range:6-50) days. Multivariate logistic regression analysis indicated that peripheral blood lymphocyte count <1 × 109/L before conditioning (OR = 4.705, P = 0.007) and haploidentical transplantation (OR = 13.161, P = 0.018) were independent risk factors for BKV-HC. The 3-year OS rate was 85.9% (95%CI:62.1%-95.2%) in the BKV-HC group and 73.1% (95%CI: 58.2%-88.0%) in the non-BKV-HC group. There was no significant difference between the two groups (P = 0.516). The 3-year PFS rate was 76.3% (95%CI: 57.9%-94.7%) in the BKV-HC group and 58.1% (95%CI: 39.5%-76.7%) in the non-BKV-HC group. There was no significant difference in the two groups (P = 0.459). The severity of BKV-HC was not related to the OS and PFS of the patients (P value was 0.816 and 0.501, respectively). CONCLUSION Haploidentical transplantation and decreased peripheral blood lymphocyte count before conditioning increased the risk of BKV-HC after allo-HSCT. The occurrence of BKV-HC after allo-HSCT and the severity of which did not affect OS and PFS of the patients.
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Affiliation(s)
- Xiang-Ting Xie
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan-Fang Zhang
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Zhang
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Han-Qing Zeng
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian-Chuan Deng
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kang Zhou
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Chen
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yun Luo
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Shi-Feng Lou
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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8
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Wo S, Cirrone F, Al-Homsi AS. A Clinical Review of the Different Strategies to Minimize Hemorrhagic Cystitis Associated with the Use of Post-Transplantation Cyclophosphamide in Allogeneic Transplantation. Transplant Cell Ther 2023; 29:210-211. [PMID: 36436781 DOI: 10.1016/j.jtct.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Stephanie Wo
- Adult Blood and Marrow Transplantation, NYU Langone Health, New York, New York.
| | - Frank Cirrone
- Adult Blood and Marrow Transplantation, NYU Langone Health, New York, New York
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9
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Uzay A, Gündoğdu Y, Koşan B, Yetiş T, Gür H, Okuturlar Y, Kartı SS. Daily low dose intravesical cidofovir for the treatment of BK virus associated hemorrhagic cystitis after allogeneic stem cell transplantation. J Infect Chemother 2022; 29:67-71. [PMID: 36162643 DOI: 10.1016/j.jiac.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/01/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION BK virus associated hemorrhagic cystitis(BKV-AHC) is a serious complication observed after allogeneic stem cell transplantation and the current therapeutic options are scarce with substantial renal side effects. Although the guidelines recommend intravenous cidofovir application with caution to nephrotoxicity, there are few studies which investigated intravesical administration and reported similar therapeutic results with less renal side effects. METHODS We administered low dose, daily and consecutive (75 mg/day, for 5 days) intravesical cidofovir to 25 patients with BKV-AHC that developed after (ASCT). RESULTS The response rate in our cohort was 92% and relapse was not encountered in 84% of the patient population during one year of follow-up. The median BK urine viral load significantly decreased from 260,000,000 IU/mL to 53,000,000 IU/mL after a week of treatment (p = 0.0001). Rise in serum creatinine was observed in 5 patients during treatment and post-treatment nephrotoxicity was seen in only 1 patient. CONCLUSIONS Daily low dose intravesical cidofovir might be an effective treatment option for BKV-AHC after ASCT with favorable less systemic side effects.
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Affiliation(s)
- Ant Uzay
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Hematology and Stem Cell Transplantation, Turkey
| | - Yasemin Gündoğdu
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Internal Medicine, Turkey.
| | - Barış Koşan
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Internal Medicine, Turkey
| | - Tuğba Yetiş
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Clinical Nursing, Turkey
| | - Hatun Gür
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Internal Medicine, Turkey
| | - Yildiz Okuturlar
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Internal Medicine, Turkey
| | - S Sami Kartı
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Hematology and Stem Cell Transplantation, Turkey
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10
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Ngo D, Samuels D, Chen J, Koller PB, Al Malki MM. A Clinical Review of the Different Strategies to Minimize Hemorrhagic Cystitis Associated with the Use of Post-Transplant Cyclophosphamide in an Allogeneic Transplant. Transplant Cell Ther 2022; 28:349-354. [PMID: 35580733 DOI: 10.1016/j.jtct.2022.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022]
Abstract
Post-transplantation cyclophosphamide (PTCy) has improved hematopoietic stem cell transplantation outcomes for patients with major HLA disparities. Although PTCy in combination with calcineurin inhibitors is a successful graft-versus-host disease regimen, giving high doses of cyclophosphamide may cause hemorrhagic cystitis (HC). The strategies used to prevent HC are adapted from published data in the pre-transplantation conditioning setting. However, there is no consensus on what the optimal strategy is to prevent PTCy-associated HC. This review provides a summary of the different preventative strategies used in this setting. Based on the results published in current literature, hyperhydration is an effective preventative strategy, but it may cause fluid overload and other complications. Additionally, mesna at least 100% of the PTCy dose should be administered as a continuous infusion or frequent intermittent bolus infusion. More comparative studies between these strategies are needed to provide a definitive solution for preventing HC associated with PTCy.
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Affiliation(s)
- Dat Ngo
- Department of Pharmacy, City of Hope, City of Hope Medical Center, Duarte, California
| | - Diana Samuels
- Department of Pharmacy, City of Hope, City of Hope Medical Center, Duarte, California
| | - Jason Chen
- Department of Pharmacy, City of Hope, City of Hope Medical Center, Duarte, California.
| | - Paul B Koller
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, City of Hope, Duarte, California
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, City of Hope, Duarte, California
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