BK 바이러스로 인한 출혈성 방광염이 발생한 소아청소년 암환자에서 cidofovir 정맥 및 방광 내 병용요법의 임상적 유효성과 안전성
Intravenous and Intravesical Cidofovir for BK Virus-Associated Hemorrhagic Cystitis in Pediatric and Adolescent Cancer Patients
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Background : BK virus-associated hemorrhagic cystitis (BKV-HC) is a common complication after allogeneic hematopoietic stem cell transplantation. Supportive measures, including painkillers, hyper-hydration, continuous bladder irrigation, transfusion, have been the standard of care for many years. Recently, clinicians have used intravenous or intravesical cidofovir for severe cases of BKV-HC. Cidofovir provides clinical improvement but has a risk of renal failure. To raise effect of remedy without increasing renal toxicity, intravenous and intravesical cidofovir combination therapy may be proposed. Methods : We retrospectively reviewed the electronic medical records of 12 pediatric and adolescent cancer patients with BKV-HC treated with 5 mg/kg intravenous and 3-5 mg/kg intravesical cidofovir weekly at an institution January 2012-June 2016. Data for hematuria and other urinary symptoms, urine and plasma BK virus titers, and serum creatinine were collected. Clinical response was defined as improvement in symptoms or reduction in cystitis grade. Microbiological response was defined as at least a 1 log reduction in urinary and blood BK viral load. Nephrotoxicity was defined as a 0.3 mg/dL or greater increase in serum creatinine at any time up to 2 weeks after treatment with cidofovir. Results : Clinical response was achieved in 8 patients (66.7%). Urinary microbiological response was recorded in 4 patients (33.3%) and blood microbiological response was in 2 patients (16.7%). Four patients presented nephrotoxicity, but 2 of them were combined with sepsis and the others represented mild symptoms. Conclusion : Intravenous and intravesical cidofovir may be a useful option to provide symptomatic relief in patients with BKV-HC, but the close monitoring about renal function should be required.
Abstract
Background : BK virus-associated hemorrhagic cystitis (BKV-HC) is a common complication after allogeneic hematopoietic stem cell transplantation. Supportive measures, including painkillers, hyper-hydration, continuous bladder irrigation, transfusion, have been the standard of care for many years. Recently, clinicians have used intravenous or intravesical cidofovir for severe cases of BKV-HC. Cidofovir provides clinical improvement but has a risk of renal failure. To raise effect of remedy without increasing renal toxicity, intravenous and intravesical cidofovir combination therapy may be proposed. Methods : We retrospectively reviewed the electronic medical records of 12 pediatric and adolescent cancer patients with BKV-HC treated with 5 mg/kg intravenous and 3-5 mg/kg intravesical cidofovir weekly at an institution January 2012-June 2016. Data for hematuria and other urinary symptoms, urine and plasma BK virus titers, and serum creatinine were collected. Clinical response was defined as improvement in symptoms or reduction in cystitis grade. Microbiological response was defined as at least a 1 log reduction in urinary and blood BK viral load. Nephrotoxicity was defined as a 0.3 mg/dL or greater increase in serum creatinine at any time up to 2 weeks after treatment with cidofovir. Results : Clinical response was achieved in 8 patients (66.7%). Urinary microbiological response was recorded in 4 patients (33.3%) and blood microbiological response was in 2 patients (16.7%). Four patients presented nephrotoxicity, but 2 of them were combined with sepsis and the others represented mild symptoms. Conclusion : Intravenous and intravesical cidofovir may be a useful option to provide symptomatic relief in patients with BKV-HC, but the close monitoring about renal function should be required.
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