■BK病毒相关的出血性膀胱炎(BK-HC)是造血干细胞移植(SCT)的一种使人衰弱且知之甚少的并发症。血尿,排尿困难,与BK-HC相关的其他症状在SCT后即刻很常见,使BK-HC难以与出现这些症状的其他疾病区分开来。尽管公布了诊断标准,这些标准在临床诊断或告知BK-HC管理的研究中持续应用的程度尚不清楚.我们介绍了一例BK-HC在儿科SCT受者中的情况,并讨论在缺乏严格数据为临床管理提供信息的情况下与治疗相关的挑战。
■我们回顾了2015年1月至2019年12月在我们中心接受SCT的所有BK病毒尿症病例。然后,我们对PubMed中针对BK-HC的出版物进行了范围审查,特别关注如何定义BK-HC。如果涉及SCT接受者的临床研究,则包括使用关键字“BK多瘤病毒”和“出血性膀胱炎”的出版物,并且全文以英文提供。病例报告被排除。分析的重点是是否明确定义了BK-HC,以及该定义是否包含了欧洲白血病感染会议(ECIL)发布的诊断标准要素。
■2018年1月至2021年6月30日期间发表的总共30项研究符合审查标准。包括4项临床试验,7项前瞻性观察性研究,和19项回顾性观察研究。其中15项研究包括儿科患者(7例仅儿科,8合并成人和儿科)。在30种出版物中,19包括BK-HC或BK膀胱炎的定义,只有五个使用ECIL标准,所有这些都是观察性研究.描述了用于治疗BK-HC的多种干预措施,包括西多福韦,来氟米特,喹诺酮类药物,高压氧,角质细胞生长因子,和BK特异性细胞毒性T淋巴细胞。然而,缺乏支持任何这些干预措施有效性的证据.
■尽管BK-HC是众所周知的SCT并发症,支持可用治疗方案的证据有限.需要结合明确诊断标准的良好对照研究来更好地定义风险因素,自然史,理想的干预措施。
UNASSIGNED: BK virus-associated hemorrhagic cystitis (BK-HC) is a debilitating and poorly understood complication of hematopoietic stem cell transplantation (SCT). Hematuria, dysuria, and other symptoms associated with BK-HC are common in the immediate post-SCT period, making BK-HC difficult to distinguish from other conditions presenting with these symptoms. Despite published criteria for diagnosis, the degree to which these criteria are consistently applied to either clinical diagnosis or to studies informing BK-HC management is unclear. We present a
case of BK-HC in a pediatric SCT recipient, and discuss the challenges associated with treatment in the absence of rigorous data to inform clinical management.
UNASSIGNED: We reviewed all cases of BK viruria at our center in patients undergoing SCT between January 2015 and December 2019. We then performed a scoping review of publications in PubMed addressing BK-HC, specifically focusing on how BK-HC was defined. Publications using the keywords \"BK polyomavirus\" and \"hemorrhagic cystitis\" were included if they involved a clinical study of SCT recipients and a full-text article was available in English.
Case reports were excluded. Analysis focused on whether BK-HC was explicitly defined and whether the definition incorporated elements of diagnostic criteria published by European Conference on Infections in Leukemia (ECIL).
UNASSIGNED: A total of 30 studies published between January 2018 and 30 June 2021 met criteria for review, including 4 clinical trials, 7 prospective observational studies, and 19 retrospective observational studies. Fifteen of these studies included pediatric patients (7 pediatric only, 8 combined adult and pediatric). Of the 30 publications, 19 included a definition of either BK-HC or BK cystitis, with only five using ECIL criteria, all of which were observational studies. Multiple interventions are described for treatment of BK-HC, including cidofovir, leflunomide, quinolones, hyperbaric oxygen, keratinocyte growth factor, and BK-specific cytotoxic T lymphocytes. However, evidence to support efficacy for any of these interventions is lacking.
UNASSIGNED: Although BK-HC is a well-known complication of SCT, evidence to support available treatment options is limited. Well-controlled studies that incorporate clear diagnostic criteria are needed to better define the risk factors, natural history, and ideal interventions.