Intravesical cidofovir to treat BK virus-associated hemorrhagic cystitis in children after hematopoietic stem cell transplantation

Pediatr Transplant. 2015 Jun;19(4):E111-4. doi: 10.1111/petr.12477. Epub 2015 Apr 16.


HC related to BK virus replication might be a severe complication following allogeneic HSCT. There are no clearly defined treatment guidelines in pediatric population. The data on the effectiveness of ICI to manage severe bleeding in children are very limited. We report our experience of intravesical cidofovir in four children, 6-15 yr of age, to manage grade III-IV BK virus-associated HC. Three of four children had high CSA serum level prior to developing cystitis. Intravesical instillations of cidofovir resulted only in temporal relief of bleeding. After immune suppression was withdrawn or tapered, intravesical instillations of formalin solution had to be undertaken to abort severe bleeding. We concluded that intravesical cidofovir alone did not appear to be sufficiently effective in case of severe HC, necessitating complimentary procedures to stop macrohematuria.

Keywords: BK virus; cidofovir; hematopoietic stem cell transplantation; hemorrhagic cystitis; intravesical instillation.

Publication types

  • Case Reports

MeSH terms

  • Administration, Intravesical
  • Adolescent
  • Antiviral Agents / administration & dosage
  • BK Virus / immunology
  • Child
  • Cidofovir
  • Cystitis / drug therapy*
  • Cystitis / etiology
  • Cytosine / administration & dosage
  • Cytosine / analogs & derivatives*
  • Female
  • Formaldehyde / administration & dosage
  • Graft vs Host Disease
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Hematopoietic Stem Cell Transplantation / methods
  • Hemorrhage / drug therapy
  • Hemorrhage / etiology
  • Humans
  • Immune System
  • Male
  • Organophosphonates / administration & dosage*
  • Polymerase Chain Reaction
  • Polyomavirus Infections / drug therapy*
  • Polyomavirus Infections / etiology
  • Time Factors


  • Antiviral Agents
  • Organophosphonates
  • Formaldehyde
  • Cytosine
  • Cidofovir