RESUMO
Although some studies have suggested the effectiveness of hyperbaric oxygen (HBO) therapy for hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (HSCT), the role of HBO has not been established. We compared the treatment outcomes of 8 patients with viral HC (adenovirus [ADV], n = 2; BK virus [BKV], n = 6) treated with HBO (HBO[+]) and 8 patients (ADV, n = 2; BKV, n = 6) treated with conventional therapy (HBO[-]), such as urinary catheterization and intravenous cidofovir. HBO therapy was performed at 2.1 atmospheres for 90 min/day until clinical improvement was achieved. The median number of HBO treatments was 10 (range 8-12). The median duration of HBO treatment was 19.5 days (range 10-23 days). All 8 HBO(+) patients achieved complete remission (CR) at a median of 14.5 days (range 5-25 days). Of the 8 HBO(-) patients, 5 (62.5%) obtained CR and 3 remained symptomatic for 2-6 months. The cumulative incidence of transplant-related mortality at day 100 after allogeneic HSCT was significantly higher in the HBO(-) patients than in the HBO(+) patients (14.2 vs. 0%, P < 0.05). No severe HBO-related adverse effects were observed. In conclusion, HBO is a feasible option for treating viral HC after allogeneic HSCT.
Assuntos
Cistite/terapia , Cistite/virologia , Transplante de Células-Tronco Hematopoéticas , Hemorragia/terapia , Hemorragia/virologia , Oxigenoterapia Hiperbárica , Adenoviridae/isolamento & purificação , Infecções por Adenoviridae/complicações , Adulto , Vírus BK/isolamento & purificação , Cistite/etiologia , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hemorragia/etiologia , Humanos , Oxigenoterapia Hiperbárica/métodos , Masculino , Pessoa de Meia-Idade , Infecções por Polyomavirus/complicações , Transplante Homólogo/efeitos adversos , Resultado do Tratamento , Adulto JovemAssuntos
Vírus BK/patogenicidade , Cistite/terapia , Hemorragia/terapia , Oxigenoterapia Hiperbárica , Infecções Oportunistas/virologia , Infecções por Polyomavirus/virologia , Infecções Tumorais por Vírus/virologia , Adolescente , Vírus BK/imunologia , Cistite/diagnóstico , Cistite/virologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hematúria/virologia , Hemorragia/diagnóstico , Hemorragia/virologia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Infecções por Polyomavirus/diagnóstico , Infecções por Polyomavirus/imunologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Resultado do Tratamento , Infecções Tumorais por Vírus/diagnóstico , Infecções Tumorais por Vírus/imunologiaAssuntos
Animais Recém-Nascidos , Doença das Mucosas por Vírus da Diarreia Viral Bovina/prevenção & controle , Doenças dos Bovinos/etiologia , Hemorragia/veterinária , Pancitopenia/veterinária , Vacinas Virais/efeitos adversos , Animais , Animais Recém-Nascidos/sangue , Bovinos , Doenças dos Bovinos/virologia , Colostro/imunologia , Colostro/virologia , Vírus da Diarreia Viral Bovina Tipo 2/imunologia , Hemorragia/etiologia , Hemorragia/virologia , Pancitopenia/etiologia , Pancitopenia/virologia , Vacinas Atenuadas/efeitos adversos , VirulênciaRESUMO
Polyoma virus BK-induced hemorrhagic cystitis is an important cause of morbidity after hematopoietic stem cell transplantation (HSCT). Fluoroquinolones have been shown in vitro to inhibit BK viral replication by direct inhibition of the BK-encoded DNA gyrase. We hypothesized that extended prophylaxis with ciprofloxacin may decrease the incidence of severe (grades 3 and 4) BK virus-associated hemorrhagic cystitis (sBKHC) after HSCT. We retrospectively collected patient and transplant data, as well as incidence of sBKHC, for all consecutive patients undergoing allogeneic HSCT between June 2006 and August 2010 at our institution. Prophylaxis for sBKHC with ciprofloxacin 500 mg orally twice daily from day 0 until day 60 had been instituted in March 2009, delimiting a group receiving ciprofloxacin prophylaxis (CP) or no prophylaxis (NP). We compared the cumulative incidence of sBKHC in CP and NP, including death in absence of sBKHC as a competing risk. Ninety-two consecutive patients were included in the analysis, 44 in CP and 48 in NP. Median age of patients was 50 years (range: 19-70), and 47% received a myeloablative conditioning regimen. The cumulative incidence of sBKHC was significantly reduced in CP (2.6% versus 20.9%, P = .01). Multivariate Cox regression analysis revealed that assignment to CP and concomitant acute graft-versus-host disease (GVHD) were the only factors independently associated with the occurrence of sBKHC. Patients in CP did not experience a higher risk of Clostridium difficile diarrhea and were less likely to develop episodes of bacteremia. Ciprofloxacin prophylaxis appears safe and effective in reducing the incidence of severe BKHC after allogeneic HSCT.