In this exclusive interview with Infectious Diseases Frontier, Professor Simone Cesaro, a leading expert in pediatric hematology and stem cell transplantation, shares his perspectives on the management of BK polyomavirus-associated hemorrhagic cystitis (HC) following hematopoietic cell transplantation (HCT). Drawing from the findings of a recent EBMT survey, he discusses the clinical implications of passive surveillance strategies, platelet transfusion thresholds, and the urgent need for consensus guidelines to support transplant centers across Europe. His insights underscore the importance of early intervention and standardization in addressing this often-overlooked complication.