Comparison of the Uroprotective Efficacy of Mesna and Hbo Treatments in Cyclophosphamide-Induced Hemorrhagic Cystitis

Etlik, Özdal; Tomur, Ahmet; Deveci, Salih; Pişkin, İlksin; Pekcan, Mesut

doi:10.1016/s0022-5347(01)68238-7

Cited by 30 publications

(16 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…20 As this treatment has been used successfully in patients with HC after pelvic radiotherapy, 17 --19 it may benefit patients with HC after HSCT. 5,10,11 To date, there have been a few case reports of successful HBO therapy in pediatric 13,15 and adult 12,14,16 patients. HBO showed a cure rate of 78.5% in pediatric patients with BKV-associated HSCT.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical effectiveness of hyperbaric oxygen therapy for BK-virus-associated hemorrhagic cystitis after allogeneic bone marrow transplantation

Savva-Bordalo

Vaz

Sousa

et al. 2011

Bone Marrow Transplant

View full text Add to dashboard Cite

Late-onset hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (HSCT) has been associated with BK virus (BKV). Antiviral drugs are of limited efficacy and the optimal treatment for HC has not yet been established. Hyperbaric oxygen (HBO) may benefit these patients. We, therefore, retrospectively evaluated the effectiveness of HBO therapy in 16 patients with HC after allogeneic HSCT. All 16 patients had macroscopic hematuria and BKV infection. Patients received 100% oxygen in a hyperbaric chamber at 2.1 atmospheres for 90 min, 5 days per week, with a median 13 treatments (range, 4 --84). Fifteen patients (94%) showed complete resolution of hematuria. Median urinary DNA BKV titers declined after HBO (Po0.05). Patients started on HBO earlier after diagnosis of HC responded sooner (Po0.05). HBO was generally well tolerated and proved to be a reliable option for this difficult to manage condition.

show abstract

Section: Discussionmentioning

confidence: 99%

“…5,10 --16 HBO has been shown effective in the treatment of radiation-induced HC, 17 --19 by promoting fibroblast proliferation and capillary angiogenesis, decreasing edema and facilitating damaged hypoxic urothelium. 11,20 We describe our experience with HBO in patients with BKV-associated HC following allogeneic HSCT.…”

Section: Introductionmentioning

confidence: 99%

Clinical effectiveness of hyperbaric oxygen therapy for BK-virus-associated hemorrhagic cystitis after allogeneic bone marrow transplantation

Savva-Bordalo

Vaz

Sousa

et al. 2011

Bone Marrow Transplant

View full text Add to dashboard Cite

show abstract

“…In the absence of adequate uroprotection, the incidence of this side effect of CYP therapy varies from 2 to 40% in patients taking low doses of CYP on a long-term basis (4). Mortality has been reported to be 2 to 4% in patients with massive hemorrhage, who were treated with a high dose of intravenous CYP (5). The cause of bladder damage appears to be related to acrolein, a urotoxic metabolite of CYP.…”

mentioning

confidence: 99%

Pharmacological and histopathological study of cyclophosphamide-induced hemorrhagic cystitis - comparison of the effects of dexamethasone and Mesna

Morais

Belarmino-Filho

Brito

et al. 1999

Braz J Med Biol Res

View full text Add to dashboard Cite

Chemotherapy with oxazaphosphorines, such as cyclophosphamide (CYP), is often limited by unacceptable urotoxicity. Without uroprotection, hemorrhagic cystitis (HC) becomes dose-limiting. To compare the uroprotective efficacy of classical 2-mercaptoethanesulfonic acid (Mesna) treatment with dexamethasone in CYP-induced HC, male Wistar rats (150-200 g; N = 6 in each group) were treated with saline or Mesna (40 mg/kg, ip) immediately and 4 and 8 h after ip administration of CYP (200 mg/kg). One, 2 or 3 doses of Mesna were replaced with dexamethasone (1 mg/kg, ip). The animals were sacrificed 24 h later. Cystitis was evaluated by determining the changes in bladder wet weight (BWW) and by macroscopic and microscopic analysis. CYP treatment induced a marked increased in BWW (162%, P<0.05), which was significantly inhibited by treatment with 3 doses of Mesna (P<0.05; 80%). The replacement of 1 or 2 doses of Mesna with dexamethasone reduced the increase in BWW by 83.3 and 95%, respectively. Macroscopic analysis of the bladder of rats with CYPinduced HC showed severe edema and hemorrhage, confirmed by microscopic analysis, that also showed mucosal erosion, inflammatory cell infiltration and ulcerations. The replacement of 1 or 2 doses of Mesna with dexamethasone inhibited the CYP-induced increase in BWW and almost abolished the macroscopic and microscopic alterations, with no significant difference between the effects of Mesna and dexamethasone, indicating that both drugs were efficient in blocking HC. However, although the replacement of all Mesna doses with dexamethasone reduced the edema, it did not prevent HC, suggesting that Mesna is necessary for the initial uroprotection.

show abstract

“…H&E ×40. model, 5 but it is not practical for the majority of patients undergoing chemotherapy or BMT. 12 The metabolites of cyclophosphamide are urotoxic and may persist in blood for 12-24 h after a single dose.…”

Section: Discussionmentioning

confidence: 99%

“…4 Very recently, the combination of mesna and hyperbaric oxygen was shown to completely eliminate HC in guinea pigs. 5 Amifostine [S-2-(3-aminopropylamino) ethyl phosphorothioic acid], designated WR-2721, is an aminothiol that is now in clinical use as a protective agent against chemotherapy-related cytotoxicities. 6 Although all the mechanisms of cytoprotection have not been fully elucidated, the most significant seems to be that the active metabolite, WR-1065, which is a thiol, acts as an intracellular scavenger of free radicals.…”

mentioning

confidence: 99%

Evaluation of uroprotective efficacy of amifostine against cyclophosphamide induced hemorrhagic cystitis

Srivastava

Nair

Srivastava

et al. 1999

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:The role of amifostine in the prevention of cyclophosphamide-induced hemorrhagic cystitis (HC) was evaluated in the rat model. Urinary bladders from control rats that received no drugs (group I) were compared with those from rats receiving cyclophosphamide alone at a dose of 150 mg/kg (group II), and two other groups receiving amifostine at 100 mg/kg (group III) and 200 mg/kg (group IV), 15 min prior to cyclophosphamide. Bladders were assessed macroscopically and histologically at 24 h and after 7 days. All the animals that received cyclophosphamide alone developed severe HC. On the basis of the scores of macroscopic and histologic changes, animals that received amifostine showed excellent uroprotection. Only 2/6 rats in group III and 1/6 rats in group IV developed mild HC at 24 h. None of the rats in either of these groups showed any evidence of HC at 7 days. It is concluded that amifostine protects the urothelium against cyclophosphamide-induced HC. Keywords: amifostine; cyclophosphamide; hemorrhagic cystitis; prevention Hemorrhagic cystitis (HC) is a potentially life-threatening sequel of therapy with oxazaphosphorine agents (cyclophosphamide, ifosfamide). It tends to occur most frequently as a consequence of using high-dose cyclophosphamide as conditioning therapy for BMT. It has been noted in 40-50% of these patients and contributes to mortality in 2-4%. 1,2 The uro-toxicity of these drugs is related to contact of the lining epithelium with the renally excreted 4-hydroxy metabolites, particularly acrolein. Other factors including viral infections, radiation and drugs such as busulfan may also cause HC in patients undergoing BMT. 2 Since there is no effective treatment for this condition, the emphasis has been on prevention. The most widely employed method for prevention is the combination of 2-mercaptoethane sodium sulfonate (MESNA) and hydration. 3 This thiol molecule has been shown to bind acrolein and reduce its toxicity. In spite of this, up to 18% of patients can develop severe manifestations (grade III to

show abstract

Comparison of the Uroprotective Efficacy of Mesna and Hbo Treatments in Cyclophosphamide-Induced Hemorrhagic Cystitis

Cited by 30 publications

References 13 publications

Clinical effectiveness of hyperbaric oxygen therapy for BK-virus-associated hemorrhagic cystitis after allogeneic bone marrow transplantation

Clinical effectiveness of hyperbaric oxygen therapy for BK-virus-associated hemorrhagic cystitis after allogeneic bone marrow transplantation

Pharmacological and histopathological study of cyclophosphamide-induced hemorrhagic cystitis - comparison of the effects of dexamethasone and Mesna

Evaluation of uroprotective efficacy of amifostine against cyclophosphamide induced hemorrhagic cystitis

Contact Info

Product

Resources

About