[CIS-PAGID] post transplant BK infection

[Nelson, Robert P Jr]

Richard,
Have seen about 15 cases post allo in adults.  Can be mild and transient or devastating-chronic, depending presumably on a number of factors:  donor source, conditioning intensity, ATG-containing conditioning/GVH prophylaxis, cyclophosphamide exposure, maybe severe GVHD and/or its treatment.  Its presence would indicate in my experience, perhaps hematological reconstitution but not immunological.   Treatment is dependent on donor source, disease for which the patient was transplanted, GVHD risk, because it may include reducing GVH-preventive therapy.  Anti-viral therapy not very potent in our experience, some try cidofavir, which carries with it significant renal toxicity.  We would be looking for CMV activation with weekly CMV PCR as a potential concommitant problem.  We anchor foley if hematuria is particulary bothersome or if clots.  We take foley out if it doesn't seem to be helping.  We try 3-way irrigation.  Anti-spasmodics may help a little.  Although it sometimes lasts for weeks or even monhts, not usually fatal.  Wide variation in BK DNA copy numbers from 10's of thousands to millions.  Initial value not especially informative but monitoring is somewhat useful I think.  Hope this helps and that the kid doesn't have a bad case of it.  Bob    
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From: pagid-bounces at list.clinimmsoc.org [pagid-bounces at list.clinimmsoc.org] on behalf of Richard Wasserman [drrichwasserman at gmail.com]
Sent: Wednesday, June 22, 2011 5:08 PM
To: PAGID
Subject: [CIS-PAGID] post transplant BK infection

My heme/onc colleagues have transplanted a two year old AML in remission who is now one month post-transplant and has reconstituted well. She would be home at this time but for severe hemorrhagic cystitis due to BK viral infection. Any suggestions?
Thank you,
Richard Wasserman

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Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
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