Haemorrhagic cystitis in haematopoietic stem cell transplantation (HSCT): a prospective observational study of incidence and management in HSCT centres within the GITMO network (Gruppo Italiano Trapianto Midollo Osseo)

Abstract

Haemorrhagic cystitis (HC) is a recognised complication in patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT). This study evaluates the incidence and severity of HC in patients undergoing allogeneic HSCT during hospitalisation and within the first 100 days following transplant, looking at the use of prophylaxis, management of HC, outcomes at 100 days post transplant, and to identify any correlations between development of HC and the different conditioning regimens for transplant or HC prevention methods used.ResultsFour hundred and fifty patients (412 adult and 38 paediatric) were enrolled in this prospective, multicentre, and observational study. HC was observed in 55 patients (12.2%) of which 8/38 were paediatric (21% of total paediatric sample) and 47/412 adults (11.4% of total adult sample). HC was observed primarily in the non-related HSCT group (45/55; 81.8%, p= 0.001) compared to sibling and myeloablative transplant protocols (48/55; 87.3%; p= 0.008) and with respect to reduced intensity conditioning regimens (7/55;12.7%).In 33 patients with HC (60%), BK virus was isolated in urine samples, a potential co-factor in the pathogenesis of HC. The median day of HC presentation was 23 days post HSCT infusion, with a mean duration of 20 days. The most frequent therapeutic treatments were placement of a bladder catheter (31/55; 56%) and continuous bladder irrigation (40/55; 73%). The range of variables in terms of conditioning regimens and so on, makes analysis difficult.ConclusionsThis multi-centre national study reported similar incidence rates of HC to those in the literature. Evidence-based guidelines for prophylaxis and management are required in transplant centres. Further research is required to look at both prophylactic and therapeutic interventions, which also consider toxicity of newer conditioning regimens.

Urological Complications and BK Virus-Associated Diseases Under Allogenic Stem Cell Transplantation

“…From data of kidney transplanted patients, we know that there is also BK-associated nephropathy, which can lead to acute renal failure and even graft loss [16]. In patients after allogenic stem cell transplantation, a correlation between BK viruria and creatinine increase or acute renal failure has not been demonstrated so far.…”

“…Several risk factors for BK virus-associated haemorrhagic cystitis have been identified so far: in retrospective studies, myeloablative conditioning, CMV viremia, acute GvHD grades 2-4 and in prospective studies, myeloablative conditioning and acute GvHD again [15,16]. However, the questions for proper risk stratification and when urological interventions are needed remain to be answered.…”

BK Virus-Hemorrhagic Cystitis Following Allogeneic Stem Cell Transplantation: Clinical Characteristics and Utility of Leflunomide Treatment

“…Hemorrhagic cystitis (HC) is a potential cause of morbidity and mortality in patients that have undergone allogeneic stem cell transplantation (Allo-SCT) [1,2,3]. Its incidence ranges from 5% to 68% of Allo-SCT recipients, with severe-grade hematuria in 29%-44% of cases [3,4,5,6,7].…”

Is polyomavirus BK the cause of hemorrhagic cystopathy in patients who undergo allogeneic hematopoietic progenitor cell transplantation?

“…The incidence is 12.2%. 1 The clinical characteristics of HC range from microscopic hematuria to severe bleeding with clot retention and even renal failure. It is an important cause of occasional morbidity and mortality in patients undergoing bone marrow transplant.…”