[CIS-PAGID] post transplant BK infection

[Ashish Kumar]

Yes, urine load is not helpful; it's the plasma load that is predictive
of outcome and severity. See recent pub
 
Biol Blood Marrow Transplant. (
http://www.ncbi.nlm.nih.gov/pubmed/21385622# ) 2011 Mar 6. [Epub
ahead of print]
Blood, and Not Urine, BK Viral Load Predicts Renal Outcome in Children
with Hemorrhagic Cystitis following Hematopoietic Stem Cell
Transplantation.Haines HL (
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Haines%20HL%22%5BAuthor%5D
), Laskin BL (
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Laskin%20BL%22%5BAuthor%5D
), Goebel J (
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Goebel%20J%22%5BAuthor%5D
), Davies SM (
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Davies%20SM%22%5BAuthor%5D
), Yin HJ (
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Yin%20HJ%22%5BAuthor%5D ),
Lawrence J (
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Lawrence%20J%22%5BAuthor%5D
), Mehta PA (
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Mehta%20PA%22%5BAuthor%5D
), Bleesing JJ (
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Bleesing%20JJ%22%5BAuthor%5D
), Filipovich AH (
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Filipovich%20AH%22%5BAuthor%5D
), Marsh RA (
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Marsh%20RA%22%5BAuthor%5D
), Jodele S (
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Jodele%20S%22%5BAuthor%5D
).
Source
Division of Bone Marrow Transplantation and Immune Deficiency,
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Abstract
BK virus is a significant cause of hemorrhagic cystitis after
hematopoietic stem cell transplantation (HSCT). However, its role in
nephropathy post-HSCT is less studied. We retrospectively evaluated
clinical outcomes in pediatric HSCT patients with hemorrhagic cystitis.
Although most of these patients had very high urine BK viral loads
(viruria), patients with higher BK plasma loads (viremia) had
significant renal dysfunction, a worse clinical course, and decreased
survival. Patients with a peak plasma BK viral load of >10,000 copies/mL
(high viremia) were more likely to need dialysis and aggressive
treatment for hemorrhagic cystitis compared to patients with ≤10,000
copies/mL (low viremia). Conversely, most patients with low viremia had
only transient elevations in creatinine, and less severe hemorrhagic
cystitis that resolved with supportive therapy. Overall survival (OS) at
1 year post-HSCT was 89% in the low viremia group and 48% in the high
viremia group. We conclude that the degree of BK viremia, and not
viruria, may predict renal, urologic, and overall outcome in the
post-HSCT population.
Copyright © 2011 American Society for Blood and Marrow Transplantation.
Published by Elsevier Inc. All rights reserved.
PMID:21385622[PubMed - as supplied by publisher] Ashish Kumar MD, PhD
Assistant Professor
BMT/Immune Deficiency
Cincinnati Children's Hospital



>>> Richard Wasserman <drrichwasserman at gmail.com> 6/23/2011 1:16 PM

>>>

The patient is currently receiving cidofovir and has a cystotomy. She
has been transfused. I don't know about plasma BK PCR. Other than
knowing more virus is bad how does one interpret the difference between
1000, 10,000, 100,000 and 1,000,000 virons? Is there data that plasma
viral load is more prognostic than urinary load?
Richard

On Thu, Jun 23, 2011 at 11:41 AM, Cowan, Mort <mcowan at peds.ucsf.edu>
wrote:



Have they gotten a plasma BK PCR? If it’s positive people have used
cidofovir with some success. If it’s just in the bladder then usually
you just treat the hemorrhagic cystitis with hydration, looking to avoid
clot formation in the bladder, until it resolves on its own. This can
take several weeks. How severe is it? Are transfusions being required
and at what frequency? I suppose you could consider cidofovir if it’s
severe enough even if not systemic infection. The issue, of course, is
the renal toxicity from cidofovir but probenecid protects the kidneys to
some extent.

Mort


Morton J. Cowan, M.D.
Professor of Pediatrics
Chief, Blood 
and Marrow Transplant Division
UCSF Children's Hospital, Room M659
505 Parnassus Ave
San Francisco, CA 94143-1278

Phone: 415-476-2188 ( tel:415-476-2188 )
FAX: 415-502-4867 ( tel:415-502-4867 )

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From:pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Kirkpatrick,
Charles
Sent: Thursday, June 23, 2011 8:43 AM
To: 'pagid at list.clinimmsoc.org'
Subject: Re: [CIS-PAGID] post transplant BK infection



Richard:

I have a patient with CVID who was also on immunosuppression for her
renal transplant. Her BK virus infection cleared when the transplant
team reduced her immunosuppressive treatment. There were no adverse
effects on kidney function.

Chuck Kirkpatrick

From:pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Richard
Wasserman
Sent: Wednesday, June 22, 2011 3:09 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
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788 ( tel:%28972%29%20566-7788 )
Fax (972) 566-8837 ( tel:%28972%29%20566-8837 )
Cell (214) 697-7211 ( tel:%28214%29%20697-7211 )




-- 
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211
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