Lee Yeon Joo, Zheng Junting, Kolitsopoulos Yovanna, Chung Dick, Amigues Isabelle, Son Tammy, Choo Kathleen, Hester Jeff, Giralt Sergio A, Glezerman Ilya G, Jakubowski Ann A, Papanicolaou Genovefa A
Department of Medicine, Infectious Disease, Memorial Sloan-Kettering Cancer Center, New York, New York.
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
Biol Blood Marrow Transplant. 2014 Aug;20(8):1204-10. doi: 10.1016/j.bbmt.2014.04.017. Epub 2014 Apr 23.
Hematopoietic stem cell transplant (HSCT) recipients are at significant risk for BK virus (BKV) reactivation, hemorrhagic cystitis (HC), and renal dysfunction. We prospectively monitored 98 patients who had received HSCT by serial BKV PCR in the urine through day (D) +100 to analyze the relationship between BK viruria and HC, serum creatinine (Cr), and creatinine clearance (CrCl) through D +180 or death. Patients, median age 52 years (range, 20 to 73), received T cell-depleted (50%) or cord blood allografts (21%). Median pre-HSCT BKV IgG titers were 1:10,240. Incremental increase in BKV IgG titers correlated with developing BK viruria ≥ 10(7) copies/mL. By D +100, 53 (54%) patients had BK viruria. BKV load in the urine increased at engraftment and persisted throughout D +100. HC developed in 10 patients (10%); 7 of 10 with BK viruria. In competing risk analyses, BK viruria ≥ 10(7) copies/mL, older age, cytomegalovirus reactivation, and foscarnet use were risk factors for HC. Cr and CrCl at 2, 3, and 6 months after HSCT were similar between patients with and without BK viruria.
造血干细胞移植（HSCT）受者发生BK病毒（BKV）再激活、出血性膀胱炎（HC）和肾功能不全的风险很高。我们对98例接受HSCT的患者进行了前瞻性监测，通过连续检测尿中BKV PCR直至第100天（D +100），以分析BK病毒尿症与HC、血清肌酐（Cr）以及至第180天（D +180）或死亡时的肌酐清除率（CrCl）之间的关系。患者的中位年龄为52岁（范围20至73岁），接受了T细胞去除（50%）或脐血同种异体移植（21%）。HSCT前BKV IgG抗体滴度的中位数为1:10,240。BKV IgG抗体滴度的递增与BK病毒尿症≥10⁷拷贝/mL的发生相关。至D +100时，53例（54%）患者出现BK病毒尿症。尿中BKV载量在植入时增加，并在整个D +100期间持续存在。10例患者（10%）发生了HC；其中10例中有7例伴有BK病毒尿症。在竞争风险分析中，BK病毒尿症≥10⁷拷贝/mL、年龄较大、巨细胞病毒再激活和使用膦甲酸钠是HC的危险因素。有和没有BK病毒尿症的患者在HSCT后2、3和6个月时的Cr和CrCl相似。
