Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Biol Blood Marrow Transplant. 2011 Oct;17(10):1512-9. doi: 10.1016/j.bbmt.2011.02.012. Epub 2011 Mar 6.
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.
BK 病毒是造血干细胞移植（HSCT）后出血性膀胱炎的重要病因。然而，其在 HSCT 后肾病中的作用研究较少。我们回顾性评估了出血性膀胱炎的儿科 HSCT 患者的临床结局。尽管这些患者的尿液 BK 病毒载量（尿病毒载量）非常高，但具有更高 BK 血浆载量（病毒血症）的患者肾功能显著受损，临床病程较差，生存率降低。与病毒载量≤10,000 拷贝/ml（低病毒血症）的患者相比，峰值血浆 BK 病毒载量>10,000 拷贝/ml（高病毒血症）的患者更有可能需要透析和积极治疗出血性膀胱炎。相反，大多数低病毒血症患者仅出现肌酐一过性升高，且出血性膀胱炎较轻，经支持治疗即可缓解。HSCT 后 1 年的总生存率（OS）在低病毒血症组为 89%，在高病毒血症组为 48%。我们得出结论，BK 病毒血症的程度，而不是尿病毒载量，可能预测 HSCT 后人群的肾脏、泌尿科和总体结局。
