Safety and Cost of Hyperhydration for the Prevention of Hemorrhagic Cystitis in Bone Marrow Transplant Recipients

Abstract

Hemorrhagic cystitis is a major cause of morbidity after bone marrow transplantation. Traditional methods of prevention have included mesna (2-mercaptoethane sodium sulfonate) and bladder irrigation. We report the use of hyperhydration as an alternative to these prophylactic measures. One hundred consecutive patients who underwent autologous or allogeneic bone marrow transplantation received high dose cyclophosphamide with hyperhydration using 5% dextrose normal saline at the rate of 250 ml/h and furosemide to maintain a urine output of >150 ml/h. Seventy-one of these patients also received high dose cyclophosphamide as mobilization chemotherapy. There were no episodes of hemorrhagic cystitis following mobilization chemotherapy. The incidence of hemorrhagic cystitis after transplant conditioning was 7% with 2 patients developing clinically significant hemorrhagic cystitis; one was a severe episode. The cost of hyperhydration was US$ 20 per course as opposed to US$ 1,500 per course for mesna, based on acquisition costs at our institution. We conclude that hyperhydration is a safe, inexpensive means of preventing hemorrhagic cystitis associated with high dose cyclophosphamide in bone marrow transplant recipients.

Protective effect of simvastatin in the cyclophosphamide-induced hemohrragic cystitis in rats

“…Some investigators reported a reduction in severe cyclophosphamide HC with the institution of a hyperhydration and forced diuresis regimen 20 . In addition to forced diuresis, have been studied the benefits of administering sodium- 21 .…”

Prevention and management of BK‐virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation – a systematic review and evidence‐based guidance for clinical management

“…Hyperhydration with forced diuresis has been studied in context of pre-engraftment HC caused by toxic metabolites of cyclophosphamide or ifosfamide. The uroprotective effect of MESNA as an uroprotective antitoxic agent has been studied as part of high-quality chemotherapy drug trials, but also in efficacy, tolerability and safety compared with hyperhydration (Shepherd et al, 1991;Ballen et al, 1999) or prophylactic bladder irrigation (Vose et al, 1993). Results are equivocal, with only one trial reporting an advantage of MESNA over forced diuresis/hyperhydration (Hows et al, 1984).…”

“…IV. administration of oestrogen at doses of 25-100 mg/d, followed by oral maintenance therapy with 5-10 mg/d (Heath et al, 2006) seemed to be more effective in reducing symptoms than oral therapy with 6-12 mg/d alone (Cheuk et al, 2007), (Shepherd et al, 1991;Vose et al, 1993;Bedi et al, 1995) 1 (Hows et al, 1984) 3 (Ballen et al, 1999) Continuous bladder irrigation (Praveen et al, 1992) 3 (Trigg et al, 1990;Levine & Jarrard, 1993;Ippoliti et al, 1995;Laszlo et al, 1995;Cesaro et al, 2003) Cidofovir instillation Alum instillation…”

Urological management (medical and surgical) of BK-virus associated haemorrhagic cystitis in children following haematopoietic stem cell transplantation

“…The uroprotective effect of 2-mercaptoethane sodium (MESNA) as a uroprotective antitoxic agent has been investigated as part of high-quality chemotherapy drug trials, and also with regards to efficacy, tolerability and safety compared with hyperhydration 5,39 or prophylactic bladder irrigation. 40 Results are equivocal, with only one trial reporting an advantage of MESNA over forced diuresis/hyperhydration.…”