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Michael Boeckh - One of the best experts on this subject based on the ideXlab platform.
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factors associated with more severe bk hemorrhagic cystitis in an allogeneic hematopoietic cell transplant cohort
Biology of Blood and Marrow Transplantation, 2019Co-Authors: Hannah Imlay, Wendy Leisenring, Louise E Kimball, Phil S Pang, Steven A Pergam, Ajit P Limaye, Michael BoeckhAbstract:Background BK polyoma virus (BKPyV) has been associated with hemorrhagic cystitis (HC) after hematopoietic cell transplant (HCT). Prior studies have examined risk factors for BKPyV-associated HC, but have been limited by inclusion of pre-engraftment hemorrhagic cystitis or cases without macroscopic hemorrhage. Few studies have examined factors associated with the clinical course of BKPyV-HC. Methods We retrospectively analyzed allogeneic HCT recipients transplanted between 2007-2017, and included all patients with BKPyV-HC (defined as macroscopic hematuria [Bedi grade >/=2] and positive urine BKPyV PCR who had at least one available plasma BKPyV viral load sample after platelet engraftment or day 28 post-HCT. Duration was determined by time to resolution of hematuria and symptoms. Demographic, transplant, viral, and immune characteristics were investigated in multivariable models using time-varying covariates to determine factors associated with resolution of macroscopic hematuria, resolution of overall symptoms, need for continuous Bladder Irrigation (CBI) or surgical intervention, need for transfusion, or development of clots by day 90 after diagnosis. Results BKPyV-HC developed in 128 allogeneic HCT recipients (70% myeloablative conditioning) at a median of 58 days post-transplant (IQR 46 – 78) and the median time to symptom resolution was 23.5 days (15 - 44). Mortality by day 90 post-BKPyV-HC diagnosis was 20% [26/128]. Plasma viral load >/=10,000 at presentation was associated with both longer duration of macroscopic hematuria and longer duration of overall symptoms [aHRs for resolution 0.31 (95% CI 0.11, 0.91), 0.32 (95% CI 0.11, 0.95), respectively], but not associated with need for continuous Bladder Irrigation or surgical intervention [HR 1.15 (95% CI 0.42, 3.14)], development of clots [HR 1.31 (95% CI 0.50, 3.46)], or need for transfusion during their course [HR 1.62 (95% CI 0.44, 5.99)]. Absolute lymphocyte count Conclusion Both immune and viral characteristics were associated with a longer duration of BKPyV-associated HC. BKPyV-associated HC is a morbid disease in need of improved management strategies; accurate descriptions of disease severity and factors associated with prolonged recovery will inform end points of future clinical trials.
Ashraf Badros - One of the best experts on this subject based on the ideXlab platform.
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cidofovir Bladder instillation for the treatment of bk hemorrhagic cystitis after allogeneic stem cell transplantation
American Journal of Hematology, 2006Co-Authors: Benjamin Bridges, Sarah Donegan, Ashraf BadrosAbstract:We report a case of severe hemorrhagic cystitis after allogeneic transplantation in association with high BK viral load. After failure of aggressive hydration, platelet and blood transfusions, continuous Bladder Irrigation, and tapering of the immune suppression, we instilled cidofovir into the Bladder, which resulted in decreased BK viral load and significant clinical improvement. Our case suggests that local cidofovir therapy for viral hemorrhagic cystitis is effective and well tolerated with no observed side effects. Am. J. Hematol. 81:535–537, 2006. © 2006 Wiley-Liss, Inc.
Kheirollah Gholami - One of the best experts on this subject based on the ideXlab platform.
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continuous Bladder Irrigation prevents hemorrhagic cystitis after allogeneic hematopoietic cell transplantation
Urologic Oncology-seminars and Original Investigations, 2008Co-Authors: Molouk Hadjibabaie, Kamran Alimoghaddam, Ahmad Reza Shamshiri, Masoud Iravani, B Bahar, Asadollah Mousavi, Mohammad Jahani, A Khodabandeh, Yasha Anvari, Kheirollah GholamiAbstract:Hemorrhagic cystitis is 1 of the most troublesome complications of hematopoietic cell transplantation conditioning regimens. We conducted a nonrandomized controlled clinical study to investigate the role of continuous Bladder Irrigation in addition to mesna, hydration, and alkalization in the prevention of hemorrhagic cystitis after allogeneic hematopoietic cell transplantation. A total of 80 eligible patients entered the study. From May 2006, 40 patients who underwent allogeneic hematopoietic cell transplantation received continuous Bladder Irrigation in addition to the common protocol. A historical control group of 40 consecutive patients with same inclusion criteria who did not receive Bladder Irrigation was enrolled from before May 2006. Hemorrhagic cystitis occurred in 50% of patients in the no Bladder Irrigation group versus 32% in Bladder Irrigation group (P = 0.11). The mean duration of hemorrhagic cystitis was significantly reduced in the Bladder Irrigation group (10 vs. 18 days; P = 0.02). Duration of hospitalization was significantly shorter in the Bladder Irrigation group (30.2 vs. 39.6; P < 0.001). Late-onset hemorrhagic cystitis that occurred beyond 4 weeks after allo-hemorrhagic cystitis happened more significantly in the no Bladder Irrigation group (P = 0.001). High-grade hemorrhagic cystitis was more frequently associated with high-grade graft-versus-host disease within 30 days after transplant (P = 0.06). In general, continuous Bladder Irrigation added to mesna, hydration, and alkalization regimens was well tolerated, decreased the complications of hemorrhagic cystitis, and may be useful in hematopoietic cell transplantation patients. However, more investigations with randomized controlled clinical trials with more patients are needed.
Gabriel P Haas - One of the best experts on this subject based on the ideXlab platform.
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prevention of hemorrhagic cystitis following allogeneic bone marrow transplant preparative regimens with cyclophosphamide and busulfan role of continuous Bladder Irrigation
The Journal of Urology, 1995Co-Authors: Levent Turkeri, Lawrence G Lum, Joseph P Uberti, E Abella, Feroze Momin, Chatchada Karanes, Lyle L Sensenbrenner, Gabriel P HaasAbstract:High dose cyclophosphamide and/or busulfan conditioning treatment of recipients of bone marrow transplants proved to be highly effective but associated with substantial and sometimes life threatening hemorrhagic cystitis. To prevent this complication, a prophylactic continuous Bladder Irrigation program was instituted in patients receiving cyclophosphamide and/or busulfan in preparation for bone marrow transplantation. Retrospective analysis of 199 patients who underwent allogeneic bone marrow transplantation revealed that continuous Bladder Irrigation significantly decreased the frequency of hemorrhagic cystitis in patients receiving busulfan and cyclophosphamide (continuous Bladder Irrigation 23% versus no Bladder Irrigation 53%, p < 0.004). There was no difference in the frequency of hemorrhagic cystitis between the different preparative regimens in patients who underwent continuous Bladder Irrigation. There was no relationship between the incidence of hemorrhagic cystitis and the severity of graft-versus-host disease or the time to engraftment. The duration of hemorrhagic cystitis and overall survival rates were similar in both groups, and there was no increase in complications related to catheterization. In general, continuous Bladder Irrigation was well tolerated, decreased the incidence of hemorrhagic cystitis and may be useful in bone marrow transplant patients.
Molouk Hadjibabaie - One of the best experts on this subject based on the ideXlab platform.
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continuous Bladder Irrigation prevents hemorrhagic cystitis after allogeneic hematopoietic cell transplantation
Urologic Oncology-seminars and Original Investigations, 2008Co-Authors: Molouk Hadjibabaie, Kamran Alimoghaddam, Ahmad Reza Shamshiri, Masoud Iravani, B Bahar, Asadollah Mousavi, Mohammad Jahani, A Khodabandeh, Yasha Anvari, Kheirollah GholamiAbstract:Hemorrhagic cystitis is 1 of the most troublesome complications of hematopoietic cell transplantation conditioning regimens. We conducted a nonrandomized controlled clinical study to investigate the role of continuous Bladder Irrigation in addition to mesna, hydration, and alkalization in the prevention of hemorrhagic cystitis after allogeneic hematopoietic cell transplantation. A total of 80 eligible patients entered the study. From May 2006, 40 patients who underwent allogeneic hematopoietic cell transplantation received continuous Bladder Irrigation in addition to the common protocol. A historical control group of 40 consecutive patients with same inclusion criteria who did not receive Bladder Irrigation was enrolled from before May 2006. Hemorrhagic cystitis occurred in 50% of patients in the no Bladder Irrigation group versus 32% in Bladder Irrigation group (P = 0.11). The mean duration of hemorrhagic cystitis was significantly reduced in the Bladder Irrigation group (10 vs. 18 days; P = 0.02). Duration of hospitalization was significantly shorter in the Bladder Irrigation group (30.2 vs. 39.6; P < 0.001). Late-onset hemorrhagic cystitis that occurred beyond 4 weeks after allo-hemorrhagic cystitis happened more significantly in the no Bladder Irrigation group (P = 0.001). High-grade hemorrhagic cystitis was more frequently associated with high-grade graft-versus-host disease within 30 days after transplant (P = 0.06). In general, continuous Bladder Irrigation added to mesna, hydration, and alkalization regimens was well tolerated, decreased the complications of hemorrhagic cystitis, and may be useful in hematopoietic cell transplantation patients. However, more investigations with randomized controlled clinical trials with more patients are needed.