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Impact of extended infusional mesna prophylaxis on the incidence of BK viruria and hemorrhagic cystitis following post-transplantation cyclophosphamide and CTLA4Ig-based haploidentical transplantation.
Annals of Hematology ( IF 3.5 ) Pub Date : 2020-02-05 , DOI: 10.1007/s00277-020-03930-w
Sarita Rani Jaiswal 1, 2, 3 , Paras Singhal 4 , Atul Thatai 5 , Gitali Bhagwati 6 , Hema Malini Aiyer 6 , Aditi Chakrabarti 1 , Suparno Chakrabarti 1, 2
Affiliation  

Hemorrhagic cystitis (HC) has been reported with increased frequency following post-transplantation cyclophosphamide (PTCy)-based haploidentical hematopoietic cell transplantation (HCT) along with a strong association with BK viruria. We prospectively evaluated the incidence of BK viruria and HC in 115 patients (median age 20 years, 2-65) undergoing PTCy-based haploidentical HCT with (n = 71) or without (n = 44) CTLA4Ig. HC prophylaxis consisted of a continuous infusion of mesna 30 min prior and 48 h post-PTCy. The overall incidence of BK viruria was 65.7%. None with BK viruria < 104 copies/ml developed clinical symptoms (n = 65). The incidence of BK viruria ≥ 104 copies/ml was 7.1% (n = 8) and 75% developed HC. The incidence of HC was 5.4% at a median of 30 days. Both BK viruria ≥ 104 copies/ml and HC were strongly associated with acute GVHD (p < 0.001). A higher NRM was observed in those with BK viruria ≥ 104 copies/ml, related to GVHD and its complications (41.7% vs 12.6%, p = 0.04). The incidences of acute GVHD, vis-à-vis, overall BK viruria, BK viruria ≥ 104 copies/ml, and HC, tended to be lower in patients receiving CTLA4Ig. Thus, extended infusional mesna, coupled with significant reduction in alloreactivity along with possible preservation of antiviral immunity associated with the use of CTLA4Ig, was probably responsible for a much lower incidence of BK viruria and resultant HC than reported previously following PTCy-based haploidentical HCT.

中文翻译:

长期预防性输注椎间盘突出对环磷酰胺和基于CTLA4Ig的单倍体移植后BK病毒尿和出血性膀胱炎发生率的影响。

据报道,基于环磷酰胺(PTCy)的单倍型造血细胞移植(HCT)移植后,出血性膀胱炎(HC)的发生频率增加,并且与BK病毒血症密切相关。我们前瞻性评估了115例接受PTCy单倍性HCT并伴有(n = 71)或不伴有(n = 44)CTLA4Ig的患者(中位年龄20岁,年龄在2-65岁)的BK病毒尿和HC发生率。HC预防包括在PTCy前30分钟和术后48小时连续输注mesna。BK病毒血症的总发生率为65.7%。BK病毒少于104拷贝/ ml的患者无临床症状(n = 65)。≥104拷贝/ ml的BK病毒血症的发生率为7.1%(n = 8)和75%的发达HC。中位30天HC的发生率为5.4%。BK病毒尿素≥104拷贝/ ml和HC与急性GVHD密切相关(p <0.001)。在BK病毒血症≥104拷贝/ ml的患者中,与GVHD及其并发症相关的NRM较高(41.7%对12.6%,p = 0.04)。接受CTLA4Ig的患者中,急性GVHD的发生率,总体BK病毒血症,BK病毒≥104拷贝/ ml和HC的发生率往往较低。因此,与基于PTCy的单倍性HCT之后报道的情况相比,延长的输注平台膜,与使用CTLA4Ig相关的抗病毒免疫力的可能保存以及同种异体反应的显着降低,可能是导致BK病毒血症和产生的HC发生率低得多的原因。接受CTLA4Ig的患者中,急性GVHD的发生率,总体BK病毒血症,BK病毒≥104拷贝/ ml和HC的发生率往往较低。因此,与基于PTCy的单倍性HCT之后报道的情况相比,延长的输注平台膜,与使用CTLA4Ig相关的抗病毒免疫力的可能保存以及同种异体反应的显着降低,可能是导致BK病毒血症和产生的HC发生率低得多的原因。接受CTLA4Ig的患者中,急性GVHD的发生率,总体BK病毒血症,BK病毒≥104拷贝/ ml和HC的发生率往往较低。因此,与基于PTCy的单倍性HCT之后报道的情况相比,延长的输注平台膜,与使用CTLA4Ig相关的抗病毒免疫力的可能保存以及同种异体反应的显着降低,可能是导致BK病毒血症和产生的HC发生率低得多的原因。
更新日期:2020-02-06
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