BK Virus Disease after Allogeneic Stem Cell Transplantation: A Cohort Analysis

Autor: Joseph H. Antin, Lindsey R. Baden, Gowri Satyanarayana, Nienke M.G. Rorije, Margaret M. Shea, Francisco M. Marty, Sarah P. Hammond, Vincent T. Ho, Robert J. Soiffer
Jazyk: angličtina
Předmět:
Male
Transplantation Conditioning
Cord blood transplantation
medicine.medical_treatment
viruses
Graft vs Host Disease
Hematopoietic stem cell transplantation
SIROLIMUS
medicine.disease_cause
Gastroenterology
Severity of Illness Index
Graft-versus-host disease
PROPHYLAXIS
Human BK polyomavirus
VERSUS-HOST-DISEASE
Prospective Studies
Prospective cohort study
Incidence (epidemiology)
Hazard ratio
Hematopoietic Stem Cell Transplantation
virus diseases
Hematology
ASSOCIATION
Middle Aged
BK virus
surgical procedures
operative

Cord blood
Hematologic Neoplasms
Female
Cord Blood Stem Cell Transplantation
Adult
medicine.medical_specialty
ONSET HEMORRHAGIC CYSTITIS
Internal medicine
medicine
Humans
Transplantation
Homologous

Cyclophosphamide
Aged
Polyomavirus Infections
Transplantation
business.industry
INTENSITY
Mycophenolic Acid
Myeloablative Agonists
medicine.disease
BONE-MARROW-TRANSPLANTATION
Allogeneic stem cell transplantation
Tumor Virus Infections
RECIPIENTS
Immunology
Chronic Disease
RISK-FACTORS
business
Zdroj: Biology of Blood and Marrow Transplantation, 20(4), 564-570. ELSEVIER SCIENCE INC
ISSN: 1083-8791
DOI: 10.1016/j.bbmt.2014.01.014
Popis: The clinical epidemiology of BK virus (BKV) disease after allogeneic hematopoietic stem cell transplantation (HSCT) is not well defined. We evaluated 491 patients transplanted from January 2010 to December 2011 at a single transplant center to assess incidence, severity, and risk factors for BIN disease after HSCT. BIN disease was defined as BIN detection in urine by PCR testing in association with genitourinary symptoms without other concurrent genitourinary conditions. BKV disease occurred in 78 patients (15.9%), for an incidence rate of.47/1000 patient-days (95% confidence interval [CI],.37 to .59); BIN disease was considered severe in 27 patients (5.5%). In multivariate Cox modeling, time-dependent acute graft-versus-host disease (aGVHD) grades ll to IV (adjusted hazard ratio [aHR14.25; 95% CI, 2.51 to 7.21), cord blood HSCT (aHR 2.28; 95% CI, 1.01 to 5.15), post-transplant mycophenolate use (aHR 3.31; 95% CI, 1.83 to 5.99), and high-dose cyclophosphamide conditioning (aHR 2.34, 95% CI 1.45 to 3.77) were significant predictors of BKV disease. Time-dependent aGVHD grades III to IV (aHR 10.5; 95% CI, 4.44 to 25.0) and cord blood HSCT (aHR 5.40; 95% CI, 1.94 to 15.0) were independent risk factors for severe BKV disease. BKV disease is common and is associated with significant and prolonged morbidity after HSCT. Prospective studies are needed to better define the morbidity of post-HSCT BKV disease and inform the design of prophylaxis and treatment trials. (C) 2014 American Society for Blood and Marrow Transplantation.
Databáze: OpenAIRE