Treatment of an adolescent with severe, refractory hemorrhagic cystitis (HC). Despite aggressive treatment of HC with supportive care, cidofovir when BK virus detected, ciprofloxacin, estrogen and 2 manual clot evacuations with intravesicular cidofovir, he remained symptomatic with significant pain, bleeding, and red cell transfusion dependent. After treatment with human keratinocyte growth factor, his refractory HC improved, and ultimately resolved.
References:
  1. Harkensee C, Vasdev N, Gennery A, et al. Prevention and management of BK-virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation – a systematic review and evidence-based guidance for clinical management. Br J Haematol . 2008;142(5):717-31.
  2. De Padua Silva L, Patah P, Saliba R, et al. Hemorrhagic cystitis after allogeneic hematopoietic stem cell transplants is the complex result of BK virus infection, preparative regimen intensity and donor type.Haematologica. 2010. July; 95(7):1183-1190.
  3. Ulich TR, Whitcomb L, Tang W, et al. Keratinocyte growth factor ameliorates cyclophosphamide-induced ulcerative hemorrhagic cystitis.Cancer Res . 1997;57(3):472-5.
  4. Czibere A, Bruns I, Graef T, et al. Treatment of severe hemorrhagic cystitis after allogeneic stem cell transplantation with palifermin, a recombinant human keratinocyte growth factor. Biol Blood Marrow Transplant. 2007;13(7):872-4.
  5. Bhaskaran S, Abu-Arja RF, Abusin G, et al. Recombinant human keratinocyte growth factor: successful treatment of severe, refractory hemorrhagic cystitis after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2014;49(12):1550-1.
  6. Yuan H, Chen G, Xu J, et al. Incidence of late-onset hemorrhagic cystitis and its effect on PFS in acute leukemia patients after haplo-PBSCT: the 5-year single-center data. Front Oncol . 2022;12:913802.
  7. Thompson A, Adamson A, and Payne H. Guidelines for the diagnosis, prevention and management of chemical- and radiation induced cystitis.J Clin Urol . 2013;7:25-35.
  8. Dave H, Luo M, Blaney JW, et al. Toward a rapid production of multivirus-specific T cells targeting BKV, Adenovirus, CMV, and EBV from umbilical cord blood. Mol Ther Methods Clin Dev . 2017;5:13-21.
  9. Abt D, Bywater M, Engeler DS, et al. Therapeutic options for intractable hematuria in advanced bladder cancer. Int J Urol . 2013;20(7):651-60.
  10. Westerman ME, Boorjian SA, Linder BJ. Safety and efficacy of intravesical alum for intractable hemorrhage cystitis: a contemporary evaluation. Int Braz J Urol . 2016;42(6):1144-1149.
  11. Palifermin [package insert]. Stockholm, Sweden: Swedish Orphan Biovitrum; 2023.
  12. Yi ES, Shabaik AS, Lacey DL, et al. Keratinocyte growth factor causes proliferation of urothelium in vivo. J Urol . 1995;154(4):1566-70.
  13. Droller MJ, Saral R, Santos G. Prevention of cyclophosphamide-induced hemorrhagic cystitis. Urology . 1982;20(3):256-8.