Intravesical Allogeneic Platelet Concentrate for Refractory BK Virus-Associated Haemorrhagic Cystitis After Allogeneic Haematopoietic Stem Cell Transplantation.
5 affiliations
- 1Department of Urology, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyıl University, 34010 Istanbul, Türkiye.
- 2Department of Haematology, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyıl University, 34010 Istanbul, Türkiye.
- 3Bone Marrow Transplantation Centre and Cell Processing Unit, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyıl University, 34010 Istanbul, Türkiye.
- 4Department of Paediatric Haematology and Oncology, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyıl University, 34010 Istanbul, Türkiye.
- 5Department of Urology, Istanbul Bilim University, 34394 Istanbul, Türkiye.
Abstract
Background/Objectives: BK virus-associated haemorrhagic cystitis (BKV-HC) is a severe complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT) for which no standard treatment exists. Intravesical platelet-rich plasma has been proposed, but recipients are profoundly thrombocytopenic, and an autologous product cannot be obtained. We report the outcome of an intravesical allogeneic platelet concentrate (allo-PC) prepared from irradiated single-donor apheresis platelets in patients refractory to all available treatment. Methods: Single-centre retrospective series of 14 consecutive patients with Grade 3-4 BKV-HC treated between January 2018 and June 2021, selected from 84 patients who developed haemorrhagic cystitis during this period. All had failed hyperhydration, forced diuresis, continuous bladder irrigation and cidofovir; 10 had undergone previous cystoscopic cauterisation, 10 had immunosuppression reduction, and 4 had hyperbaric oxygen, all without resolution. The median duration of haematuria before allo-PC was 45.5 days. The primary outcome was resolution of macroscopic haematuria; transfusion requirement, catheter removal and readmission were reported separately. Results: Macroscopic haematuria resolved in 12 of 14 patients (85.7%, 95% CI 60.1-96.0) after a median of 5.5 days (IQR 4.0-12.5). Seven patients (50.0%, 95% CI 26.8-73.2) met all secondary criteria. Product platelet concentration correlated inversely with time to resolution (rs = -0.917, 95% CI -0.977 to -0.725). Because a fixed 50 mL volume was given, the delivered dose varied 18-fold (0.30-5.62 × 10⁹ platelets/kg). Body weight also correlated with time to resolution (rs = +0.791), but in partial correlation the association with platelet concentration persisted after adjustment for weight (rs = -0.783, p = 0.004) and for age (rs = -0.827, p = 0.002), whereas the association with weight did not persist after adjustment for platelet concentration (rs = +0.292, p = 0.38). No procedure-related complication exceeded Clavien-Dindo Grade I. Conclusions: In patients who had exhausted all available treatment, intravesical allo-PC was followed by resolution of haematuria in most cases. The association between product platelet content and time to resolution was not explained by body weight or age. These uncontrolled findings are hypothesis-generating.
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BibTeX
@article{guleser2026intravesical,
title = {{Intravesical Allogeneic Platelet Concentrate for Refractory BK Virus-Associated Haemorrhagic Cystitis After Allogeneic Haematopoietic Stem Cell Transplantation.}},
author = {Ahmet Semih Güleser and Hasan Sami Göksoy and Zeynep Doğuşan and Dilek Ece and Atakan Eren and Aslıhan Sezgin and Nurgül Özgür Yurttaş and Özkan Onuk and Barış Malbora and Fatih Altunrende},
journal = {Journal of clinical medicine},
year = {2026},
month = sep,
doi = {10.3390/jcm15197407},
url = {https://europepmc.org/article/MED/42881869},
note = {CC BY},
}
RIS
TY - JOUR
TI - Intravesical Allogeneic Platelet Concentrate for Refractory BK Virus-Associated Haemorrhagic Cystitis After Allogeneic Haematopoietic Stem Cell Transplantation.
AU - Ahmet Semih Güleser
AU - Hasan Sami Göksoy
AU - Zeynep Doğuşan
AU - Dilek Ece
AU - Atakan Eren
AU - Aslıhan Sezgin
AU - Nurgül Özgür Yurttaş
AU - Özkan Onuk
AU - Barış Malbora
AU - Fatih Altunrende
PY - 2026
DA - 2026/09/24
JO - Journal of clinical medicine
DO - 10.3390/jcm15197407
UR - https://europepmc.org/article/MED/42881869
AB - Background/Objectives: BK virus-associated haemorrhagic cystitis (BKV-HC) is a severe complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT) for which no standard treatment exists. Intravesical platelet-rich plasma has been proposed, but recipients are profoundly thrombocytopenic, and an autologous product cannot be obtained. We report the outcome of an intravesical allogeneic platelet concentrate (allo-PC) prepared from irradiated single-donor apheresis platelets in patients refractory to all available treatment. Methods: Single-centre retrospective series of 14 consecutive patients with Grade 3-4 BKV-HC treated between January 2018 and June 2021, selected from 84 patients who developed haemorrhagic cystitis during this period. All had failed hyperhydration, forced diuresis, continuous bladder irrigation and cidofovir; 10 had undergone previous cystoscopic cauterisation, 10 had immunosuppression reduction, and 4 had hyperbaric oxygen, all without resolution. The median duration of haematuria before allo-PC was 45.5 days. The primary outcome was resolution of macroscopic haematuria; transfusion requirement, catheter removal and readmission were reported separately. Results: Macroscopic haematuria resolved in 12 of 14 patients (85.7%, 95% CI 60.1-96.0) after a median of 5.5 days (IQR 4.0-12.5). Seven patients (50.0%, 95% CI 26.8-73.2) met all secondary criteria. Product platelet concentration correlated inversely with time to resolution (rs = -0.917, 95% CI -0.977 to -0.725). Because a fixed 50 mL volume was given, the delivered dose varied 18-fold (0.30-5.62 × 10⁹ platelets/kg). Body weight also correlated with time to resolution (rs = +0.791), but in partial correlation the association with platelet concentration persisted after adjustment for weight (rs = -0.783, p = 0.004) and for age (rs = -0.827, p = 0.002), whereas the association with weight did not persist after adjustment for platelet concentration (rs = +0.292, p = 0.38). No procedure-related complication exceeded Clavien-Dindo Grade I. Conclusions: In patients who had exhausted all available treatment, intravesical allo-PC was followed by resolution of haematuria in most cases. The association between product platelet content and time to resolution was not explained by body weight or age. These uncontrolled findings are hypothesis-generating.
SN - 2077-0383
ER -