Comparison of intravenous or intravesical cidofovir in the treatment of BK polyomavirus-associated hemorrhagic cystitis following adult allogeneic stem cell transplantation-A systematic review

Transpl Infect Dis. 2018 Aug;20(4):e12914. doi: 10.1111/tid.12914. Epub 2018 Jun 21.

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: There is only weak evidence for the use of CDV. The intravesical admission route should be further investigated because of a good toxicity profile.

Keywords: BK virus; BK-associated hemorrhagic cystitis; allogeneic stem cell transplantation; cidofovir.

Publication types

  • Comparative Study
  • Review
  • Systematic Review

MeSH terms

  • Administration, Intravenous
  • Administration, Intravesical
  • Adult
  • Antiviral Agents / administration & dosage*
  • BK Virus / drug effects
  • BK Virus / isolation & purification
  • Cidofovir
  • Cystitis / blood
  • Cystitis / drug therapy*
  • Cystitis / virology
  • Cytosine / administration & dosage
  • Cytosine / analogs & derivatives
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Hemorrhage / blood
  • Hemorrhage / drug therapy*
  • Hemorrhage / virology
  • Humans
  • Organophosphonates / administration & dosage
  • Polyomavirus Infections / blood
  • Polyomavirus Infections / drug therapy*
  • Polyomavirus Infections / virology
  • Randomized Controlled Trials as Topic
  • Treatment Outcome
  • Tumor Virus Infections / blood
  • Tumor Virus Infections / drug therapy*
  • Tumor Virus Infections / virology
  • Viral Load / drug effects

Substances

  • Antiviral Agents
  • Organophosphonates
  • Cytosine
  • Cidofovir