[CIS-PAGID] post transplant BK infection

[Aly.Mageed at helendevoschildrens.org]

I agree with Dr Nelson. I would also add that a low dose cidofovir has been helpful with lower renal and hematopoietic risks. We have used 0.5-1 mg/kg 2-3 times a week with hydration and without probenecid rather than the typical 5 mg/kg/week with probenecid with ? quicker resolution (hard to compare to historical control with so much variability between cases). We also check for adeno in addition to CMV. 
In prolonged cases, other measures with cystoscopy and clot removal as well as prostaglandin  (carboprsot) irrigation or the use of estrogen are considered

Aly Mageed, MD
Division Chief, Pediatric Blood & Marrow Transplant
Helen DeVos Children's Hospital and Michigan State University
(616)-391-3962
aly.mageed at helendevoschildrens.org

-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Nelson, Robert P Jr
Sent: Wednesday, June 22, 2011 5:33 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS-PAGID] post transplant BK infection

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    
________________________________________
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

--
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
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