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Abstract: SA-PO116

Urinary Cell BKV-VP1 mRNA Levels in Early Symptomatic Hemorrhagic Cystitis and Kidney Injury in Hematopoietic Stem Cell Transplant Recipients

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Gutgarts, Victoria, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Snopkowski, Catherine, Weill Cornell Medicine, New York, New York, United States
  • Lee, Yeon Joo, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Jakubowski, Ann A., Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Papanicolaou, Genovefa A., Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Glezerman, Ilya, Memorial Sloan Kettering Cancer Center, New York, New York, United States
  • Suthanthiran, Manikkam, Weill Cornell Medicine, New York, New York, United States
  • Dadhania, Darshana M., Weill Cornell Medicine, New York, New York, United States
Background

Asymptomatic BK virus (BKV) viruria is frequent (up to 60%) peri hematopoietic stem cell transplantation (HCT), however a minority develop BKV hemorrhagic cystitis (HC). We aimed to determine if BKV-VP1 mRNA levels, previously validated urinary biomarker of BKV nephropathy (Dadhania et al, Transplantation 2010) can predict HC and acute kidney injury (AKI) within 3 months of HCT.

Methods

Urine samples were collected prospectively from adults undergoing first allogeneic HCT at MSKCC. 4 samples (median) per patient were collected within 3 months of HCT. Urine cell pellets were prepared, total RNA isolated and reverse transcribed to cDNA. Real-time quantitative PCR was used to measure BKV-VPI mRNA copy number/ug of total RNA. HC was defined as grades 1 to 4; microscopic to macroscopic hematuria with clots, respectively. AKI was defined as Cr > 1.5x baseline at 3 months of HCT.

Results

19 HCT recipients (median age 45, range 24-73, 53% acute leukemia) were profiled and 5 (26%) developed symptomatic HC (4 graded as 1, 1 graded as 3) within 3 months. Eight patients developed AKI at 3 months, majority grade 1. The Figure below shows the average number of BKV VP1 copies per patient. Although the median number of copies were not significantly different between those who developed symptomatic HC and not and those who developed AKI and not in the first three months of HCT, levels in 4 patients exceeded BKV nephropathy (BKVN) diagnostic threshold (>6.5×108 BKV VP1 mRNA /microgram RNA).

Conclusion

Our novel finding that the BKV VP1 mRNA level exceeded BKVN diagnostic threshold in 21% cases raise the hypothesis that BKVN may be an underappreciated entity in HCT recipients.