Incidence and treatment of hemorrhagic cystitis in children given hematopoietic stem cell transplantation: a survey from the Italian association of pediatric hematology oncology–bone marrow transplantation group

Abstract

Summary:The purpose of this multicenter study was to assess the incidence and the treatment of hemorrhagic cystitis (HC) in 1218 pediatric patients, with a mean age of 10.8 years, who underwent hematopoietic stem cell transplantation (HSCT). In all, 44 patients (3.6%) developed HC a median 23 days after HSCT. The incidence of HC was higher in allogeneic than in autologous HSCT recipients (P ¼ 0.0001). Of the 44 patients, 37 (84%) recovered from HC in a median 30 days (range 3-100); the other seven children died while still suffering from HC. Hyperbaric oxygen therapy (HOT) achieved significantly better results than prostaglandin therapy (P ¼ 0.02) in the treatment of grade II-III HC. By multivariate analysis, age o96 months and allogeneic HSCT were significantly associated with the occurrence of HC: P ¼ 0.008 and 0.013, respectively. After a median follow-up of 5.75 years, the 5-year survival of patients who did or did not develop HC was: 43 vs 52%, P ¼ 0.03, respectively. This study indicates that age and type of HSCT are factors predisposing to HC in children given HSCT and demonstrates the promising role of HOT in a conservative approach to HC treatment. Bone Marrow Transplantation (2003) 32, 925-931.

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

“…Furthermore, two pediatric cohort studies reported an impact on mortality. 34,36 A single-center study has previously documented a longer median hospital stay for patient developing BKV-HC during the first 100 days after transplant (41 vs 26 days). 10 Our findings show that BKV-HC requires a median additional 10 days of hospitalization per patient, which represents 85% of the additional cost.…”

Relationship between clinical and BK virological response in patients with late hemorrhagic cystitis treated with cidofovir: a retrospective study from the European Group for Blood and Marrow Transplantation

“…18 In a single-center study on pediatric patients and in a retrospective study on adult and pediatric patients, the lack of recovery from HC has been associated with both a higher transplant-related mortality (72% vs 40%), and lower survival (43% vs 52%). 3,14 One issue still debated is the optimal dosage of CDV. Bernhoff et al…”

“…In allogeneic hematopoietic SCT (HSCT), hemorrhagic cystitis (HC) is a serious complication of the early post-engraftment period with a variable incidence from 3 to 70% [1][2][3] but in more recent reports it has occurred in 20-30% of patients. [4][5][6] Generally, HC is a painful complication that additionally prolongs the hospital stay for supportive measures, increases the need for blood transfusions, and, in the severe form, may obstruct the urinary tract.…”

“…Moreover, its occurrence has been associated with an increased mortality. 3,5,7 From a pathogenic point of view, the uncontrolled replication of BK virus (BKV) in the bladder mucosa in the first weeks after transplant together with the immunological reaction of acute GVHD seems to have a key role in triggering sudden-onset hematuria. 8,9 Cidofovir (CDV) is an acyclic nucleoside analog with broad spectrum antiviral activity.…”

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

“…Routine therapy for HC is based on intensive supportive treatment with hyperhydration, constant bladder irrigation, pain management and red cell or platelet transfusions. 2,13 Encouraging results with antiviral agents have been published; however, there is no evident proof in a large number of patients and mainly improve clinical symptoms. [14][15][16][17] The use of formalin, alum, prostaglandin E1, estrogens, FVIIa, factor XIII, hyperbaric oxygen treatment, intravesicular sodium hyaluronate, recombinant human epidermal growth factor or recombinant human GM-CSF has been described, but their efficacy remains controversial.…”