Pediatric Hematology-Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden.
J Antimicrob Chemother. 2018 Jan 1;73(1):12-21. doi: 10.1093/jac/dkx324.
To define guidelines for BK polyomavirus (BKPyV)-associated haemorrhagic cystitis (BKPyV-HC) after paediatric and adult HSCT.
Review of English literature and evidence-based recommendations by expert consensus.
BKPyV-HC occurs in 8%-25% of paediatric and 7%-54% of adult recipients undergoing allogeneic HSCT. Diagnosis requires the triad of cystitis, macro-haematuria and high urine BKPyV loads >7 log10 copies/mL, and exclusion of other relevant aetiologies. BKPyV viraemia is frequent and may serve as a more specific semiquantitative follow-up marker. No randomized controlled trials are available to inform antiviral prophylaxis or treatment. However, hyper-hydration and/or bladder irrigation showed limited prophylactic value. Fluoroquinolones are not effective for prophylaxis or treatment, but rather increase antibiotic resistance. Hyperbaric oxygen or fibrin glue is marginally effective based on small case series from correspondingly equipped centres. Although cidofovir has been reported to improve and/or reduce BKPyV viraemia or viruria, the current data do not support its regular use.
BKPyV-HC remains a disabling unmet clinical need in HSCT that requires novel approaches supported by proper clinical trials.
为小儿和成人造血干细胞移植（HSCT）后 BK 多瘤病毒（BKPyV）相关出血性膀胱炎（BKPyV-HC）定义指南。
对英文文献进行综述，并通过专家共识制定基于证据的推荐意见。
在接受异基因 HSCT 的小儿中，BKPyV-HC 的发生率为 8%-25%，而成人则为 7%-54%。诊断需要三联征：膀胱炎、肉眼血尿和尿液 BKPyV 负荷>7 log10 拷贝/mL，排除其他相关病因。BKPyV 血症较为常见，可作为更具特异性的半定量随访标志物。目前尚无随机对照试验来指导抗病毒预防或治疗。然而，高水化和/或膀胱冲洗的预防效果有限。氟喹诺酮类药物对预防或治疗无效，反而会增加抗生素耐药性。高压氧或纤维蛋白胶的疗效有限，仅基于相应设备齐全的中心的小病例系列。虽然报道称更昔洛韦可改善和/或减少 BKPyV 血症或病毒血症，但目前的数据不支持其常规使用。
BKPyV-HC 仍然是 HSCT 中一种未满足的严重临床需求，需要有适当临床试验支持的新方法。
