1887
Volume 2021, Issue 3
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Allogeneic stem cell transplant recipients are at risk of BK virus-associated hemorrhagic cystitis. This condition causes a significant morbidity and worsens clinical outcomes. The standard cares for BK virus-associated hemorrhagic cystitis are saline irrigation and forced diuresis. Notably, several beneficial roles are proposed for antiviral and anti-inflammatory agents against BK virus-associated hemorrhagic cystitis. However, cases who are at risk of cystectomy remain refractory. Herein, we present a 13-year-old boy with severe hematuria by passing two months from his allogeneic stem cell transplantation. The laboratory work up showed high BK viremia >1.1 ×  108 copies/ml in this case's urine sample. The patient was treated with antiviral agents in combination with supportive care. Moreover, intravesical alum was administered, but no clinical benefits were achieved. Finally, intravesical alprostadil was prepared under the supervision of a pediatric clinical pharmacist. In this regard, an alprostadil solution was prepared by constitution of 250 μg alprostadil in 50 mL saline. After administrating the first dose of intravesical alprostadil, an acceptable clinical response was observed, and hematuria stopped. Of note, alprostadil induces platelet aggregation and vasoconstriction. Thus, bleeding can be controlled after the administration of intravesical alprostadil. This strategy may be associated with several side effects including bladder spasm. This study is the first report describing the special role of intravesical alprostadil in refractory cases of BK virus-associated hemorrhagic cystitis. In such refractory cases, clinicians can use intravesical alprostadil rather than invasive therapies in the treatment of BK virus-hemorrhagic cystitis.

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2021-10-07
2024-11-05
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References

  1. Mohammadi Najafabadi M, Soleimani M, Ahmadvand M, et al. Treatment protocols for BK virus associated hemorrhagic cystitis after hematopoietic stem cell transplantation. Am J Blood Res 2020; 10:(5):217–230.
    [Google Scholar]
  2. Atilla E, Ates¸ C, Uslu A, et al. Prospective analysis of hemorrhagic cystitis and BK viremia in allogeneic hematopoietic stem cell transplantation. Turk J Haematol 2020; 37:(3):186–192.
    [Google Scholar]
  3. Krajewski W, Kamin′ska D, Poterek A, et al. Pathogenicity of BK virus on the urinary system. Cent European J Urol 2020; 63:(2):94–103.
    [Google Scholar]
  4. Held TK, Biel SS, Nitsche A, et al. Treatment of BK virus-associated hemorrhagic cystitis and simultaneous CMV reactivation with cidofovir. Bone Marrow Transplant 2000; 26:(3):347–350.
    [Google Scholar]
  5. Savona MR, Newton D, Frame D, et al. Low-dose cidofovir treatment of BK virus-associated hemorrhagic cystitis in recipients of hematopoietic stem cell transplant. Bone Marrow Transplant 2007; 39:(12):783–787.
    [Google Scholar]
  6. Tang FF, Zhang XH, Chen H, et al. Surgical treatment of severe, refractory hemorrhagic cystitis following allogeneic hematopoietic stem cell transplantation: a report of 17 patients. Zhonghua Nei Ke Za Zhi 2017; 56:(6):414–418.
    [Google Scholar]
  7. Demir HA, Savas¸ S¸en Z, Altuğ MU, et al. Successful treatment of cyclophosphamide-induced haemorrhagic cystitis with intravesical prostaglandin E1 in a child with non-Hodgkin's lymphoma. Scand J Urol Nephrol 2011; 45:(4):281–284.
    [Google Scholar]
  8. Castagnetti M, Angelini L, Alaggio R, et al. Oncologic outcome and urinary function after radical cystectomy for rhabdomyosarcoma in children: role of the orthotopic ileal neobladder based on 15-year experience at a single center. J Urol 2014; 191:(6):1850–1855.
    [Google Scholar]
  9. Moschini M, Simone G, Stenzl A, et al. Critical review of outcomes from radical cystectomy: can complications from radical cystectomy be reduced by surgical volume and robotic surgery? Eur Urol Focus 2016; 2:(1):19–29.
    [Google Scholar]
  10. Miller SB. Prostaglandins in health and disease: an overview. Semin Arthritis Rheum 2006; 36:(1):37–49.
    [Google Scholar]
  11. Aldiwani M, Tharakan T, Al-Hassani A, et al. BK virus associated haemorrhagic cystitis. a systematic review of current prevention and treatment strategies. Int J Surg 2019; 63:(3):34–42.
    [Google Scholar]
  12. Hanchanale V and Eardley I. Alprostadil for the treatment of impotence. Expert Opin Pharmacother 2014; 15:(3):421–428.
    [Google Scholar]
  13. Liang M, Yang S and Fu N. Efficacy of alprostadil in preventing contrast-induced nephropathy in patients undergoing percutaneous coronary intervention: A multicenter prospective randomized controlled trial. 2018; 91:(4):742–750.
    [Google Scholar]
  14. Acciavatti A, Laghi Pasini F, Capecchi PL, et al. Effects of alprostadil on blood rheology and nucleoside metabolism in patients affected with lower limb chronic ischaemia. Clin Hemorheol Microcirc 2001; 24:(1):49–57.
    [Google Scholar]
  15. Neves-Zaph SR. Phosphodiesterase diversity and signal processing within cAMP signaling networks. Adv Neurobiol 2017;17:3–14.
    [Google Scholar]
  16. Batla A, Tayim N, Pakzad M, et al. Treatment options for urogenital dysfunction in Parkinson's disease. Curr Treat Options Neurol 2016; 18:(10):45–45.
    [Google Scholar]
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  • Article Type: Research Article
Keyword(s): allogeneic stem cell transplantalprostadilBK virus and hemorrhagic cystitis
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