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Intravenous and Intravesical Cidofovir for BK Virus-Associated Hemorrhagic Cystitis in Pediatric and Adolescent Cancer Patients
J. Kor. Soc. Health-syst. Pharm. 2018;35:9-19
Published online February 28, 2018
© 2018 Korean Society of Health-System Pharmacists

Min Kyeong Kima, Yoon Sun Reea, Jae Song Kima, Eun Sun Sona,† and Chuhl Joo Lyub

Department of Pharmacya, Department of Pediatric Hematology and Oncologyb, Severance Hospital, Yon-sei University Health System, 50-1 Yonsei-ro, Seodeamun-gu, Seoul, 03722, Republic of Korea
Correspondence to: 손은선 Tel:02-2228-6888 E-mail:SESPHARM@yuhs.ac
Received January 26, 2017; Revised February 27, 2017; Accepted December 28, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background : BK virus-associated hemorrhagic cystitis (BKV-HC) is a common complication after allogeneic hematopoietic stem cell transplantation. Supportive measures, including painkillers, hyper-hydration, continuous bladder irrigation, transfusion, have been the standard of care for many years. Recently, clinicians have used intravenous or intravesical cidofovir for severe cases of BKV-HC. Cidofovir provides clinical improvement but has a risk of renal failure. To raise effect of remedy without increasing renal toxicity, intravenous and intravesical cidofovir combination therapy may be proposed.
Methods : We retrospectively reviewed the electronic medical records of 12 pediatric and adolescent cancer patients with BKV-HC treated with 5 mg/kg intravenous and 3-5 mg/kg intravesical cidofovir weekly at an institution January 2012-June 2016. Data for hematuria and other urinary symptoms, urine and plasma BK virus titers, and serum creatinine were collected. Clinical response was defined as improvement in symptoms or reduction in cystitis grade. Microbiological response was defined as at least a 1 log reduction in urinary and blood BK viral load. Nephrotoxicity was defined as a 0.3 mg/dL or greater increase in serum creatinine at any time up to 2 weeks after treatment with cidofovir.
Results : Clinical response was achieved in 8 patients (66.7%). Urinary microbiological response was recorded in 4 patients (33.3%) and blood microbiological response was in 2 patients (16.7%). Four patients presented nephrotoxicity, but 2 of them were combined with sepsis and the others represented mild symptoms.
Conclusion : Intravenous and intravesical cidofovir may be a useful option to provide symptomatic relief in patients with BKV-HC, but the close monitoring about renal function should be required.
Keywords : BK virus-associated hemorrhagic cystitis, Cidofovir, Intravesical cidofovir


August 2018, 35 (3)