Analysis of Hemorrhagic Cystitis and BK Viremia in Children after Hematopoietic Stem Cell Transplantation

Purpose: Hemorrhagic cystitis (HC) which occurs in 9%-31% of recipients after hematopoietic stem cell transplantation (HSCT) is an important cause of morbidity and mortality. Various treatment approaches have been applied for such as conservative treatments (hydration, analgesic agents, antibiotics), intravesical treatments (bladder irrigation, hyaluronic acid, and prostaglandin E), intravenous or intravesical antiviral agents, hyperbaric oxygen, and surgical treatments. Materials and Methods: This retrospective study included two hundred thirty-three children who underwent HSCT in Pediatric Bone Marrow Transplantation unit between April 2010 and June 2017. Results: Ten patients (4.2%) developed HC. The mean age of patients was 12.8 years and the mean duration of the onset of HC was 20 days. Urine and blood BK polyomavirus were positive in nine and four patients, respectively. Six patients received intravesical hyaluronic acid, three patients received intravesical prostaglandin E, three patients received intravenous ganciclovir, two patients received intravenous and/or intravesical cidofovir and hyperbaric oxygen treatment. The mean time of recovery from hematuria was 43 days. This study showed that the BK polyomavirus has an important role in the development of HC in HSCT patients, as in harmony with the literature. HC has been successfully treated in eight patients with supportive measures and/or intravesical hyaluronic acid. Conclusions: BK polyomavirus plays an important role in the development of HC pediatric patients. Intravesical hyaluronic acid, besides supportive measures, was effective for the treatment of HC and hyperbaric oxygen may be reserved for refractory cases.