Turkish Journal of Hematology Volume: 33 - Issue: 3

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Park YH, et al: BK Virus-Hemorrhagic Cystitis Turk J Hematol 2016;33:223-230 20. Wu KH, Weng T, Wu HP, Peng CT, Sheu JN, Chao YH. Effective treatment of severe BK virus-associated hemorrhagic cystitis with leflunomide in children after hematopoietic stem cell transplantation: a pilot study. Pediatr Infect Dis J 2014;33:1193-1195. 21. Chen XC, Liu T, Li JJ, He C, Meng WT, Huang R. Efficacy and safety of leflunomide for the treatment of BK virus-associated hemorrhagic cystitis in allogeneic hematopoietic stem cell transplantation recipients. Acta Haematol 2013;130:52-56. 22. Przepiorka D, Anderlini P, Saliba R, Cleary K, Mehra R, Khouri I, Huh YO, Giralt S, Braunschweig I, van Besien K, Champlin R. Chronic graft-versushost disease after allogeneic blood stem cell transplantation. Blood 2001;98:1695-1700. 23. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, Thomas ED. 1994 Consensus conference on acute GVHD grading. Bone Marrow Transplant 1995;15:825-828. 24. Kim SY, Lee JW, Lee KM, Cho BS, Eom KS, Kim YJ, Lee S, Min CK, Kim HJ, Cho SG, Kim DW, Min WS, Kim CC. Viruria in adult hemorrhagic cystitis patients following allogeneic hematopoietic stem cell transplantation and implication of antiviral treatment. Korean J Hematol 2007;42:114-121. 25. Gorczynska E, Turkiewicz D, Rybka K, Toporski J, Kalwak K, Dyla A, Szczyra Z, Chybicka A. Incidence, clinical outcome, and management of virusinduced hemorrhagic cystitis in children and adolescents after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2005;11:797-804. 26. Gilis L, Morisset S, Billaud G, Ducastelle-Lepretre S, Labussiere-Wallet H, Nicolini FE, Barraco F, Detrait M, Thomas X, Tedone N, Sobh M, Chidiac C, Ferry T, Salles G, Michallet M, Ader F; Lyon BK Virus Study Group. High burden of BK virus-associated hemorrhagic cystitis in patients undergoing allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2014;49:664-670. 27. Vats A, Shapiro R, Singh Randhawa P, Scantlebury V, Tuzuner A, Saxena M, Moritz ML, Beattie TJ, Gonwa T, Green MD, Ellis D. Quantitative viral load monitoring and cidofovir therapy for the management of BK virus-associated nephropathy in children and adults. Transplantation 2003;75:105-112. 28. Kadambi PV, Josephson MA, Williams J, Corey L, Jerome KR, Meehan SM, Limaye AP. Treatment of refractory BK virus-associated nephropathy with cidofovir. Am J Transplant 2003;3:186-191. 29. Thamboo TP, Jeffery KJ, Friend PJ, Turner GD, Roberts IS. Urine cytology screening for polyoma virus infection following renal transplantation: the Oxford experience. J Clin Pathol 2007;60:927-930. 30. Gonzalez-Fraile MI, Canizo C, Caballero D, Hernandez R, Vazquez L, Lopez C, Izarra A, Arroyo JL, de la Loma A, Otero MJ, San Miquel JF. Cidofovir treatment of human polyomavirus-associated acute haemorrhagic cystitis. Transpl Infect Dis 200;3:44-46. 31. Held TK, Biel SS, Nitsache A, Kurth A, Chen S, Gelderblom HR, Sieqert W. Treatment of BK virus-associated hemorrhagic cystitis and simultaneous CMV reactivation with cidofovir. Bone Marrow Transplant 2000;26:347-350. 32. Hatakeyama N, Suzuki N, Kudoh T, Hori T, Mizue N, Tsutsumi H. Successful cidofovir treatment of adenovirus-associated hemorrhagic cystitis and renal dysfunction after allogenic bone marrow transplant. Pediatr Infect Dis J 2003;22:928-929. 33. Leung AY, Suen CK, Lie AK, Liang RH, Yuen KY, Kwong YL. Quantification of polyoma BK viruria in hemorrhagic cystitis complicating bone marrow transplantation. Blood 2001;98:1971-1978. 230
RESEARCH ARTICLE DOI: 10.4274/tjh.2015.0079 Turk J Hematol 2016;33:231-235 A Randomized Study Comparing the Efficacy of Three Hepatitis B Vaccine Induction Regimens in Adult Patients with Hematological Malignancies Erişkin Hematolojik Maligniteli Hastalarda Üç Tip Hepatit B Aşılama Rejimini Karşılaştıran Randomize Bir Çalışma Zübeyde Nur Özkurt, Elif Suyanı, Rauf Haznedar, Münci Yağcı Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey Abstract Objective: Non-responsiveness to hepatitis B virus (HBV) vaccines is not rare in hemato-oncological patients due to disease-associated or treatment-induced immune suppression. Although different strategies have been employed to improve the response rates, to date there is not an approved schedule for HBV immunization in patients with hematological malignancies. We designed a prospective randomized study to evaluate the efficacy of 3 different induction regimens for HBV vaccination. Materials and Methods: In the standard-dose (SD) group, total vaccine dose delivered was 40 µg and patients were vaccinated with 20 µg at weeks 0 and 4. In the high-dose dose-intensive (HDDI) group, total vaccine dose delivered was 80 µg and patients were vaccinated with 40 µg at weeks 0 and 4. In the high-dose time-intensive (HDTI) group, total vaccine dose delivered was 80 µg and patients were vaccinated with 20 µg at weeks 0, 2, 4, and 6. Results: In a cohort of 114 patients, 38.6% responded to HBV vaccination. The response rate in the SD arm, HDDI arm, and HDTI arm was 26.2%, 29.7%, and 44.4%, respectively (p>0.05). Age was the only variable identified as having a negative impact on response. Conclusion: Short of achieving statistical significance, a higher response rate was observed in the HDTI arm. Therefore, this study supports a high-dose, time-intensive HBV vaccine induction regimen in patients with hematological malignancies who are not on chemotherapy. Keywords: Hepatitis B, Vaccine, Hematological malignancies Amaç: Hematolojik maliniteli hastalarda hastalık veya tedavi ilişkili immün baskılanma yüzünden Hepatit B virüsü (HBV) aşısı yanıtsızlığı nadir değildir. Aşı yanıtını düzeltecek yöntemler denenmiş olsa da hematolojik maligniteli hastalarda kabul görmüş bir protokol henüz mevcut değildir. Öz Öz Gereç ve Yöntemler: Üç farklı HBV aşılama rejimini karşılaştıran ileriye dönük ve randomize bir çalışma tasarlandı. Standart doz (SD) grubuna toplam 40 µg olmak üzere 0. ve 4. haftada 20 µg HBV aşısı yapıldı. Yüksek doz-doz yoğun (YDDY) gruba toplam 80 µg HBV aşısını 0. ve 4. haftada 40 µg uygulandı. Yüksek doz-sık uygulama (YDSU) grubuna toplam 80 µg HBV aşısı 0., 2., 4. ve 6. haftalarda 20 µg yapıldı. Bulgular: Yüz on dört hastayı içeren bu çalışmada HBV aşısına yanıt %38,6 bulundu. Yanıt oranı SD, YDDY ve YDSU kolu için yanıt sırası ile %26,2, %29,7 ve %44,7 bulundu (p>0,05). Aşı yanıtı üzerine olumsuz etkili tek değişkenin yaş olduğu saptandı. Sonuç: İstatistiksel anlamı olmasa da YDSU kolunda HBV aşı yanıtı oransal olarak daha yüksek bulundu. Bu çalışmada elde edilen sonuçlar hematolojik maligniteli hastalarda yüksek doz ve daha sık uygulanan HBV aşılama rejiminin daha etkin olduğunu düşündürmektedir. Anahtar Sözcükler: Hepatit B, Aşılama, Hematolojik malignite Introduction Hepatitis B virus (HBV) infection, the most common chronic viral infection in the world, can have serious clinical complications ranging from fulminant hepatitis to cirrhosis and hepatocellular carcinoma [1]. Vaccination is most effective in preventing HBV infection and complications. The complete vaccine series induce protective antibody levels in more than 95% of infants, children, and young adults. Protection has been estimated to last at least 20 years and is possibly lifelong [2]. It is generally held that patients Address for Correspondence/Yazışma Adresi: Zübeyde Nur ÖZKURT, M.D., Gazi University Faculty of Medicine, Department of Hematology, Ankara, Turkey Phone : +90 312 202 63 17 E-mail : zubeydenurozkurt@yahoo.com Received/Geliş tarihi: February 10, 2015 Accepted/Kabul tarihi: September 28, 2015 231
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