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Incidence, risk factors and outcome of BK virus hemorrhagic cystitis following allogenic hematopoietic cell transplantation: a retrospective cohort study

Bone Marrow Transplantation volume 57, pages 1287–1294 (2022)Cite this article

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Abstract

BK polyomavirus (BKPyV) can cause hemorrhagic cystitis (HC) after allogeneic hematopoietic cell transplantation (allo-HCT). Recent evaluation of BKPyV HC (BKHC) incidence and risk factors are scarce. We conducted a retrospective single-center study on a recent allo-HCT cohort over 3 years in a referral academic hospital for hematological malignancies. Primary objective was to determine BKHC incidence using competitive risk analysis. Secondary objectives were the identification of HC risk factors using Fine and Gray models and the evaluation of mortality. Among 409 allo-HCT recipients (median age 47 years), 41 developed BKHC after a median delay of 41 [32–55] days. Incidence density of BKHC was 2.4 [1.8–3.1] events per 100 days post-allo-HCT. The proportion of BKHC after adjustment for time-dependent competing risk was 9.5 [9.5–9.6]% at 100 days. BK viremia was detected in 63 versus 20% in tested patients with and without BKHC, respectively. After adjustment for confounders, myeloablative conditioning regimen with and without cyclophosphamide and CMV seropositivity were independently associated with BKHC. Post-transplantation cyclophosphamide was not associated with BKHC. BKHC resolved in 90% of the patients. No difference in mortality was found between patients with or without BKHC. In parallel to the recent evolution of allo-HCT protocols, BKHC remains a frequent complication following allo-HCT.

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Fig. 1: Competing risk of cumulative incidence of BKHC in allograft recipients.
Fig. 2: Cumulative survival of allograft patients according to the occurrence of BKHC.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Author notes

  1. These authors contributed equally: Gérard Socié, Jean-Michel Molina.

  2. These authors jointly supervised this work: Gérard Socié, Jean-Michel Molina.

Authors and Affiliations

  1. Département des Maladies Infectieuses et Tropicales des Hôpitaux Saint-Louis/Lariboisière, Paris, France

    Anastasia Saade, Julien Gras & Jean-Michel Molina

  2. Service d’hématologie, greffe, hôpital Saint-Louis, Paris, France

    Anastasia Saade, David Michonneau, Aliénor Xhaard, Régis Peffault De Latour & Gérard Socié

  3. Université de Paris, Paris, France

    Anastasia Saade, Julien Gras, Michael Darmon, David Michonneau, Linda Feghoul, Jérôme Le Goff, Régis Peffault De Latour, Gérard Socié & Jean-Michel Molina

  4. INSERM U944 « Biology of emerging viruses” Team, Saint Louis Research Institute, Paris, France

    Julien Gras & Jean-Michel Molina

  5. Center of Epidemiology and Biostatistics, INSERM, Université de Paris, ECSTRA Team, UMR 1153, Paris, France

    Michael Darmon

  6. INSERM U976 HIPI – INSIGHT Team, Saint Louis Research Institute, Paris, France

    David Michonneau, Jérôme Le Goff & Gérard Socié

  7. Service d’hématologie adolescents et jeunes adultes, hôpital Saint-Louis, Paris, France

    Nathalie Dhedin

  8. Laboratoire de virologie, hôpital Saint-Louis, Paris, France

    Linda Feghoul & Jérôme Le Goff

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Contributions

AS, JG, GS and JMM were responsible for designing the review protocol. AS and JG collected the missing data after extraction. AS performed data management. AS and MD were responsible for analysing data. AS, JG, MD, DM, ND, LF, JLG, AX, RPD, GS and JMM were responsible for interpreting results. AS and JG were responsible for writing the protocol. AS, JG, DM, MD, AX, LF, GS and JMM were responsible for writing the manuscript. AS, JG, DM, MD, ND, AX, LF, JLG, RPD, GS and JMM were responsible for proofreading and editing.

Corresponding authors

Correspondence to Anastasia Saade or Jean-Michel Molina.

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Saade, A., Gras, J., Darmon, M. et al. Incidence, risk factors and outcome of BK virus hemorrhagic cystitis following allogenic hematopoietic cell transplantation: a retrospective cohort study. Bone Marrow Transplant 57, 1287–1294 (2022). https://doi.org/10.1038/s41409-022-01665-y

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