Schneidewind Laila, Neumann Thomas, Schmidt Christian Andreas, Krüger William
Department of Haematology/Oncology, University Medicine Greifswald, Greifswald, Germany.
Transpl Infect Dis. 2018 Aug;20(4):e12914. doi: 10.1111/tid.12914. Epub 2018 Jun 21.
BK polyomavirus can lead to hemorrhagic cystitis (BKPyV-HC) in allogeneic stem cell transplantation and therefore to increased morbidity. No causal therapy has been established yet. Cidofovir (CDV) is a nucleotide analog of cytosine that is active against various DNA viruses and it has been described for therapy of BKPyV-HC using 2 admission routes: intravenous and intravesical.
We performed a systematic review regarding the comparison of intravenous or intravesical cidofovir in the treatment of BKPyV-HC following adult allogeneic stem cell transplantation. Since there is a lack of randomized controlled trials, we considered all kinds of studies for this review. Due to heterogeneity of the data, we were not able to perform a meta-analysis, so the results are shown descriptively.
The literature search for primary studies yielded 232 results. Finally, 9 studies where considered which included a total of 189 adult patients with BKPyV-HC after allogeneic stem cell transplantation. We could only identify retrospective studies for this review. A total of 172 patients received intravenous CDV, 17 patients received intravesical CDV, and 2 patients received CDV in both admission routes. In 68.0% of the cases, a complete response for intravenous CDV was documented and in 88.2% for intravesical CDV. Interestingly, no kidney toxicity was mentioned in intravesical CDV. 9.3% of the intravenously treated patients had renal failure.
There is only weak evidence for the use of CDV. The intravesical admission route should be further investigated because of a good toxicity profile.
BK多瘤病毒可导致异基因干细胞移植患者发生出血性膀胱炎（BKPyV-HC），进而增加发病率。目前尚未确立因果性治疗方法。西多福韦（CDV）是胞嘧啶的核苷酸类似物，对多种DNA病毒具有活性，已有文献报道其可通过静脉和膀胱内两种给药途径治疗BKPyV-HC。
我们对成人异基因干细胞移植后静脉或膀胱内注射西多福韦治疗BKPyV-HC的比较进行了系统评价。由于缺乏随机对照试验，我们纳入了各类研究进行本评价。由于数据的异质性，我们无法进行荟萃分析，因此结果采用描述性呈现。
对原始研究的文献检索产生了232条结果。最终，纳入9项研究，共189例异基因干细胞移植后发生BKPyV-HC的成年患者。本评价仅纳入了回顾性研究。共有172例患者接受静脉注射CDV，17例患者接受膀胱内注射CDV，2例患者两种给药途径均接受了CDV治疗。静脉注射CDV的病例中，68.0%记录为完全缓解，膀胱内注射CDV的病例中这一比例为88.2%。有趣的是，膀胱内注射CDV未提及肾毒性。静脉治疗的患者中有9.3%发生肾衰竭。
使用CDV的证据不足。鉴于膀胱内给药途径毒性良好，应进一步研究。
