Clinical effectiveness of early treatment with hyperbaric oxygen therapy for severe late‐onset hemorrhagic cystitis after hematopoietic stem cell transplantation in pediatric patients

Abstract

HC is a possible cause of morbidity and extended hospitalization after HSCT. Recent studies have reported the efficiency of HOT in adult patients who underwent allogeneic HSCT, but data in children are scarce. We report our single center experience with HOT in late-onset HC after HSCT. Treatment with HOT consisted of daily sessions of breathing 100% O(2) for a total of 75 min in the hyperbaric chamber with a minimum of eight sessions. HOT had been associated with a concomitant treatment with oral oxybutynin, hyperhydration and/or irrigation of the bladder through the catheter. Cidofovir had been administered based on the demonstration of viral infection. Between 2004 and 2011, 10 patients developed severe HC after a median of 26 days after HSCT. HOT was started after a median of six days since the clinical diagnosis of HC. After a median of 10 sessions of HOT, seven of 10 patients were in complete remission. HOT is a well-tolerated procedure also in the pediatric setting. The early start of HOT might be effective in the treatment of HC offering advantages in terms of duration of symptoms and hospitalization.

Choreito Formula for BK Virus–associated Hemorrhagic Cystitis after Allogeneic Hematopoietic Stem Cell Transplantation

“…In a pediatric cohort of 10 children with BKV-HC grade ! II, 9 (90%) achieved CR after a median of 15 days (range, 10 to 37 days), including spontaneous resolution [22]. Hyperbaric oxygen is generally well tolerated; however, it requires a high-cost facility and adverse effects have been reported, including ruptured tympanum.…”

“…Hyperbaric oxygen therapy is another alternative treatment for BKV-HC [11,22]. A retrospective study included 16 patients with BKV-HC grade !…”

Effects and long‐term follow‐up of using umbilical cord blood–derived mesenchymal stromal cells in pediatric patients with severe BK virus‐associated late‐onset hemorrhagic cystitis after unrelated cord blood transplantation

“…In 2006, MSCs were isolated from the placenta and umbilical cord tissues in China, which have stronger proliferation and differentiation abilities, convenient collection, and high purity. Since then, umbilical cord blood‐derived MSCs have become an ideal substitute for bone marrow‐derived MSCs and have a greater potential for application . MSCs have a strong self‐renewal ability and multidirectional differentiation potential.…”

“…Mesenchymal stromal cells were first found in the bone marrow; however, the preparation of MSCs from damaged bone mar- and have a greater potential for application. 22 MSCs have a strong self-renewal ability and multidirectional differentiation potential.…”

Hyperbaric oxygen as a treatment modality in cyclophosphamide‐induced hemorrhagic cystitis

“…Daily sessions result in improved microcirculation and better elimination of toxins around the lesions, leading to decreased inflammation and enhanced healing while preserving bladder function . HBO2 has been attempted in treatment of refractory HC and is a safe therapeutic modality but continues to be sparingly used for this indication, especially in children . In this review, we report 2 cases that had persistent symptoms despite first‐ and second‐line treatments, but responded well to HBO2.…”