Hemorrhagic Cystitis Complicating Bone Marrow Transplantation
Section snippets
MATERIAL AND METHODS
At our institution, the standard conditioning regimen for allogeneic bone marrow transplantation in patients with a neoplasm has been cyclophosphamide (60 mg/kg daily for 2 days) in conjunction with fractionated total-body irradiation (1,325 cGy twice daily for 3 days). In patients with aplastic anemia, we have administered cyclophosphamide in a dosage of 50 mg/kg daily for 4 days. All our patients have been prophylactically treated with forced hydration with use of saline (250 ml/h) beginning
RESULTS
Among the initial 97 patients who received standard prophylaxis, we noted 4 cases of symptomatic hemorrhagic cystitis (4%; 90% confidence interval, 1.1 to 8.5%). All four patients also had active graft-versus-host disease at the time of onset of hemorrhagic cystitis. In one patient, the hemorrhagic cystitis subsided without treatment; the three other patients required hydration and continuous bladder irrigation before the hematuria resolved.
Four consecutive patients who underwent allogeneic
DISCUSSION
Despite the fact that our report does not include prospectively randomized patients, the extremely low incidence of symptomatic hemorrhagic cystitis among our initial 97 patients is striking and compares favorably with other reported series. Two essential factors are careful insertion of the irrigation catheter to minimize trauma and diligent nursing supervision to record urinary output. Because our preliminary experience does not substantiate that uroprophylaxis with mesna is as effective as
ACKNOWLEDGMENT
We acknowledge the work of Barbara A. Schafer, R.N., and all the paramedical personnel who devoted time and effort to the care of the patients in this study.
REFERENCES (9)
- et al.
Prevention of cyclophosphamide-induced hemorrhagic cystitis
Urology
(1982) - et al.
Comparison of mesna with forced diuresis to prevent cyclophosphamide induced haemorrhagic cystitis in marrow transplantation: a prospective randomised study
Br J Cancer
(1984) - et al.
Hemorrhagic cystitis—a manifestation of graft versus host disease?
Bone Marrow Transplant
(1987) - et al.
Haemorrhagic cystitis in bone marrow transplantation patients: possible increased risk associated with prior busulphan therapy
Bone Marrow Transplant
(1987)
Cited by (25)
Hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation: Donor type matters
2004, BloodCitation Excerpt :Although mild forms usually resolve with supportive treatment, severe HC may require antiviral therapy such as vidarabine, hyperbaric oxygen treatment, amifostine, factor XIII, bladder irrigation with intravesicular instillation of E-aminocaproic acid, methyl prednisolone or formalin, cystoscopy and cauterization, and even cystectomy.4-12 In general, alkylating agents such as cyclophosphamide (CTX), radiation therapy, or adenovirus and BK polyoma virus infection have been implicated in the etiology of HC.13-24 However, previous studies evaluating risk factors for HC have been carried out on either small numbers of patients or in heterogeneous populations including different preparative regimens.1,16,20,21
High-dose chemotherapy regimens for solid tumors
1995, Cancer Treatment ReviewsAllogeneic Bone Marrow Transplantation: Problems and Prospects
1992, Mayo Clinic Proceedings