Abstract
PurposeHemorrhagic cystitis (HC) is a frequent complication of allogeneic hematopoietic stem-cell transplantation (HSCT). HC worsens transplant outcomes and patient wellbeing in terms of pain, hospitalization, and need for supportive care. A deeper understanding of the risk factors of HC may lead to more intensive prevention in high-risk patients.MethodsIn this report, we analyzed 237 consecutive patients who received HSCT with the aim of identifying possible risk factors for HC and their consequences, with a particular focus on transplant- and gender-related risk factors.ResultsHC occurred in 17% of patients, with a higher incidence in males (21% vs 11%, p = 0.03). Risk factors identified for HC included age over 55 years, male recipient, HLA mismatch, reduced intensity conditioning, and cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis. Increased HC was seen in patients with grade II–IV acute GVHD and detectable BKV and JCV viruria. In a multivariate model, increased age remained significant (p = 0.013). Patients with HC had longer hospitalizations and increased non-relapse mortality (NRM). Among male recipients, independent risk factors for HC included age (p = 0.016) and prostate volume (p = 0.016). Prostatic hyperplasia (volume more than 40 cm3) occurred in 33% of male patients, of which 32% developed HC (compared with 16% of patients without prostatic hyperplasia; p = 0.032).ConclusionsAge is the most important risk factor for HC. Additional potential risk factors include cyclophosphamide-based GVHD prophylaxis and HLA mismatch. Among male recipients, prostatic hyperplasia is an additional independent risk factor. As HC is common and associated with prolonged hospitalization, more intensive prophylactic strategies should be considered in high-risk patients.
Highlights
Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative cell therapy for patients with hematologic malignancies
The majority of patients (76%) received a myeloablative conditioning regimen (MAC) consisting of thiotepa-busulfan-fludarabine (TT-Bu-Flu) [15] or fludarabine and 12 Gy total body irradiation (Flu-TBI); the remaining 24% of patients received a reduced-intensity conditioning (RIC) regimen consisting of fludarabine, cyclophosphamide, and 2 Gy TBI (Baltimore) or TT-Bu-Flu with reduced doses of busulfan
We aimed to evaluate how patient and transplant characteristics affect the development of hemorrhagic cystitis (HC)
Summary
Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative cell therapy for patients with hematologic malignancies. Conditioning chemotherapy may be myeloablative (MAC) or reduced-intensity (RIC), according to diagnosis, stem cell source, and the general condition of the patient. Different regimens are known to affect the duration and severity of cytopenias, and in some cases, the durability of disease control [1]. After infusion of stem cells, acute or chronic graft-versus-host disease (a/c-GVHD) may be observed with variable grades of severity. Causes of nonrelapse mortality (NRM) include multiorgan toxicity, infections, and hemorrhages occurring during pancytopenia, as well as GVHD. Hemorrhagic cystitis (HC) is another commonly observed toxicity of HSCT.
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