The Prevalence, Risk Factors and Quinolone Response in Children with BK Virus-Associated Hemorrhagic Cystitis after...

The objective of this study was to examine the prevalence, risk factors, and response to quinolones of BK virus-associated hemorrhagic cystitis (BKV-HC) after hematopoietic stem cell transplantation (HSCT) in children. Patients with HC were divided into two groups according to whether their hematuria was BKV-related or not: BKV-associated-HC in Group 1 (n = 27), non-BKV-HC in Group 2 (n = 10). In Group 1, the subgroup analysis was performed as quinolone response for BKV (Ciprofloxacin-subgroup-1a, n = 15 and Levofloxacin-subgroup-1b, n = 10). The clinical, virological, and quinolone responses were recorded. Hemorrhagic cystitis has been identified in 37 (18.5%) of 200 children undergoing HSCT. Of them, 27 (13.5%) were BKV-HC in Group 1, while the remaining 10 (5%) were associated with other viruses (EBV, CMV, and Adenovirus) in Group 2. For BKV-HC, fifteen patients (55%) treated with ciprofloxacin and ten patients (37%) treated with levofloxacin showed complete clinical and virological responses. The two remaining unresponsive patients to quinolones (8%) died. Individuals in subgroup-1a had significantly delayed the disappearance of macroscopic and microscopic hematuria, as well as negative BKV-PCR titers, compared to those in subgroup-1b (p < 0.05). Risk variables for BKV-HC included male donors, unrelated donors, use of anti-thymocyte globulin, steroid dose (≥ 2 mg/kg), and steroid duration (> 2 weeks) (p < 0.05). Our findings indicate that BKV-HC is more common than other viruses-HC, that identifying risk factors, particularly steroid dose and duration, can be helpful in BKV-HC prevention, and that levofloxacin may be an alternate treatment for BKV-HC if ciprofloxacin is ineffective in children undergoing allogeneic HSCT.