Hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation: donor type matters

Abstract

Hemorrhagic cystitis (HC) remains a common complication of allogeneic blood and marrow transplantation. Previous analyses of risk factors for this complication were performed in heterogenous populations, with dissimilar diagnosis and conditioning regimens. We postulated that HC is more prevalent in matched unrelated donor (MUD) and unrelated cord blood (UCB) transplantations than in matched related donor (MRD) transplantations. We performed a retrospective study on 105 acute lymphocytic leukemia patients treated with 12 Gy total body irradiation-based regimens and allogeneic transplants (MUD, n ‫؍‬ 38; UCB, n ‫؍‬ 15; mismatched related, n ‫؍‬ 20; MRD, n ‫؍‬ 32). HC occurred in 16% of patients receiving MRD transplants, 30% of recipients of mismatched related, and 40% of MUD or UCB transplants (hazard ratio 2.9, 95% CI 1.0-7.9 for the comparison of MRD versus MUD). The excessive rate of HC among MUD and UCB patients became evident after the first 30 days after transplantation. Recipients younger than 26 years had a significantly higher incidence of HC (HR 2.5, 95% CI 1.1-5.8). This donor type and age effect was independent of platelet engraftment, development of graftversus-host disease (GVHD), source of stem cells, use of anti-thymocyte globulin (ATG) or cyclophosphamide in the regimen, steroid use, or stem cell source. We concluded that HC is more prevalent in MUD and UCB transplantations. (Blood.

Selective embolization of the internal iliac arteries for the treatment of severe hemorrhagic cystitis following hematopoietic SCT

“…[9][10][11][12] Other reported factors include GVHD, unrelated BM or cord blood transplants, radiation and exposure to BU. 1,[34][35][36] The Embolization treatment of hemorrhagic cystitis after HSCT Y Han et al immune reactions play an important role in the pathogeneses of LOHC, which may lead to the immune attack of the recipient urothelium, causing more damage than the simple toxic effects of chemotherapy or the cytopathic effects of viral infections. Initially, the toxicity to the uroepithelium and immunosuppression caused by the conditioning regimen provides suitable conditions for viral replication.…”

“…Hemorrhagic cystitis (HC) is recognized as a significant cause of morbidity and sometimes mortality in patients undergoing hematopoietic SCT (HSCT) [1][2][3] shows a clinical manifestation varying from microscopic hematuria to severe hemorrhage with obstructive renal failure. 4,5 Its reported incidence ranges from less than 10% to more than 70% due to the discrepancies in definition criteria and the types of transplant.…”

High burden of BK virus-associated hemorrhagic cystitis in patients undergoing allogeneic hematopoietic stem cell transplantation

“…Regarding risk factors, different studies have shown several levels of risk but CBU remains the highest risk in the HSCT settings. 10,22 In our study, CBU transplantation is the most significant risk factor for BKV-HC with a 38% cumulative incidence. Another study has previously proposed a risk stratification combining the type of donor and the HLA matching with a cumulative incidence of BKV-HC among patients receiving CBU, unrelated donor, mismatched related donor and matched related donor of 40%, 40%, 30% and 16%, respectively.…”

“…Another study has previously proposed a risk stratification combining the type of donor and the HLA matching with a cumulative incidence of BKV-HC among patients receiving CBU, unrelated donor, mismatched related donor and matched related donor of 40%, 40%, 30% and 16%, respectively. 22 Another issue is the role of HLA mismatching as a cofactor for BK viruria as previously shown. 15 Although we showed that HLA mismatching and unrelated donor are cofactors in univariate analysis, multivariate analysis did not confirm it as independent risk factors.…”

“…Previous studies have suggested a causal relationship between acute GvHD and the development of BKV-HC 25,27,35 but this was not confirmed in recent studies. 1,10,11,17,22 Acute GvHD-related immunosuppressive therapy may favor viral opportunistic reactivations. 18,22 Here, when studying acute GvHD as a timedependent variable, no correlation with BKV-HC was found.…”