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Background BK virus infection in Allo-HCT pediatric patients is associated with the development of hemorrhagic cystitis (HC) leading to increased morbidity and prolonged hospitalization. We described the baseline characteristics, clinical presentation, and outcomes associated with recent BK virus infections at St. Jude Children’s Research Hospital. Methods We identified all pediatric Allo-HCT recipients with a positive blood or urine test for BKV at St. Jude between 2010 and 2018. A retrospective review of the electronic medical records (EMR) was conducted for demographics, signs, and symptoms associated with BKV infection, complications, and outcomes. Descriptive statistics were used to summarize the cohort. Results Of 475 patients who received an Allo-HCT during the study period, 209 (44%) had at least one positive test for BKV. Most were male (60%) and mean age was 12.4 years. BKV was most common in haploidentical transplants (n = 65), followed by match unrelated donor and matched sibling donor. Sixty-seven (32%) had only viruria, 5 (2%) had only viremia, and 137 (66%) had both. Of those with a positive result for BKV, 169 (80%) presented with hematuria or were diagnosed with HC. Urologic interventions were required by 22% of the patients; 40 required continuous bladder irrigation and 9 underwent cystoscopy. Despite having BKV detected in urine and/or blood, 17% had no symptoms. Conclusions A large proportion of Allo-HCT patients developed BKV associated HC. Morbidity associated with HC is important, with 1 in 5 patients requiring urology intervention.

#94: BK Virus (BKV) Infections in Pediatric Allogeneic Hematopoietic Cell Transplant (Allo-HCT) Patients: A Single-center Experience