Umeda Katsutsugu, Kato Itaru, Kawaguchi Koji, Tasaka Keiji, Kamitori Tatsuya, Ogata Hideto, Mikami Takashi, Hiramatsu Hidefumi, Saito Ryoichi, Ogawa Osamu, Takahashi Takayuki, Adachi Souichi
Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan.
Pediatr Transplant. 2018 Jun;22(4):e13183. doi: 10.1111/petr.13183. Epub 2018 Apr 14.
BKV-HC is a serious complication of allogeneic HSCT. To characterize the incidence, risk factors, and clinical outcomes of post-HSCT BKV-HC, we retrospectively analyzed 112 patients who underwent one or more allogeneic HSCTs at our hospital between 2001 and 2017. Twenty underwent second or third HSCT thereafter. Ten patients developed BKV-HC at a median of 30 days after HSCT. The 100-day cumulative incidences of grade 0-4 and grade 2-4 BKV-HC were 7.8% and 6.2%, respectively. HSCTs performed in 2011-2017 associated with significantly higher 100-day cumulative incidence of grade 2-4 BKV-HC (14.0%) than HSCTs performed in 2001-2010 (1.3%, P = 0.004). On multivariate analysis, second or third HSCT was the only independent significant risk factor for development of grade 2-4 BKV-HC (P = 0.015). Serial PCR monitoring of urine and blood BKV load did not predict BKV-HC. The recent increase in the incidence of BKV-HC may reflect recent innovations in transplant technologies that facilitate second or third HSCT, which are known to cause prolonged immune deficiency. If safe and effective treatment or prophylaxis becomes available, it could be used to target the high-risk patients for BKV-HC.
BK病毒相关性出血性膀胱炎（BKV-HC）是异基因造血干细胞移植（HSCT）的一种严重并发症。为了明确HSCT后BKV-HC的发病率、危险因素及临床结局，我们回顾性分析了2001年至2017年间在我院接受一次或多次异基因HSCT的112例患者。其中20例之后接受了第二次或第三次HSCT。10例患者在HSCT后中位30天发生了BKV-HC。0-4级和2-4级BKV-HC的100天累积发病率分别为7.8%和6.2%。2011-2017年进行的HSCT与2-4级BKV-HC的100天累积发病率（14.0%）显著高于2001-2010年进行的HSCT（1.3%，P = 0.004）。多因素分析显示，第二次或第三次HSCT是发生2-4级BKV-HC的唯一独立显著危险因素（P = 0.015）。对尿液和血液中BK病毒载量进行连续PCR监测并不能预测BKV-HC。近期BKV-HC发病率的增加可能反映了移植技术的最新创新，这些创新促进了第二次或第三次HSCT，而这已知会导致长期免疫缺陷。如果有安全有效的治疗或预防方法，可用于针对BKV-HC的高危患者。
