Hemorrhagic cystitis after allogeneic hematopoietic cell transplantation: risk factors, graft source and survival

• Published in: Bone marrow transplantation (Basingstoke) Vol. 50; no. 11; pp. 1432 - 1437
• Main Authors: Lunde, L E, Dasaraju, S, Cao, Q, Cohn, C S, Reding, M, Bejanyan, N, Trottier, B, Rogosheske, J, Brunstein, C, Warlick, E, Young, J A H, Weisdorf, D J, Ustun, C
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-11-2015; Nature Publishing Group
• Subjects: 692/499; 692/700/565/2319; Adolescent; Adult; Age Factors; Allografts; Bone marrow; Cell Biology; Child; Child, Preschool; Cohort Studies; Complications and side effects; Cord blood; Cyclophosphamide; Cyclophosphamide - adverse effects; Cyclophosphamide - therapeutic use; Cystitis; Cystitis - chemically induced; Cystitis - epidemiology; Cystitis - etiology; Cytomegalovirus Infections - complications; Female; Fever; Graft vs Host Disease - complications; Graft vs Host Disease - epidemiology; Graft-versus-host reaction; Grafting; Hematology; Hematopoietic stem cell transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hemorrhage; Hemorrhage - epidemiology; Hemorrhage - etiology; Hemorrhagic cystitis; Hemorrhagic disorders; Histocompatibility antigen HLA; Humans; Incidence; Infant; Infant, Newborn; Internal Medicine; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; original-article; Patients; Precision medicine; Prophylaxis; Public Health; Risk analysis; Risk Factors; Sex Factors; Stem cell research; Stem cell transplantation; Stem Cells; Survival; Survival Analysis; Thrombocytopenia; Thrombocytopenia - epidemiology; Thrombocytopenia - etiology; Transplantation; Transplantation Conditioning - adverse effects; Umbilical cord; Viruria; Virus Activation; Young Adult
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/bmt.2015.162

Although hemorrhagic cystitis (HC) is a common complication of allogeneic hematopoietic cell transplantation (alloHCT), its risk factors and effects on survival are not well known. We evaluated HC in a large cohort (
n
=1321, 2003–2012) receiving alloHCT from all graft sources, including umbilical cord blood (UCB). We compared HC patients with non-HC (control) patients and examined clinical variables at HC onset and resolution. Of these 1321 patients, 219 (16.6%) developed HC at a median of 22 days after alloHCT. BK viruria was detected in 90% of 109 tested HC patients. Median duration of HC was 27 days. At the time of HC diagnosis, acute GVHD, fever, severe thrombocytopenia and steroid use were more frequent than at the time of HC resolution. In univariate analysis, male sex, age <20 years, myeloablative conditioning with cyclophosphamide and acute GVHD were associated with HC. In multivariate analysis, HC was significantly more common in males and HLA-mismatched UCB graft recipients. Severe grade HC (grade III–IV) was associated with increased treatment-related mortality but not with overall survival at 1 year. HC remains hazardous and therefore better prophylaxis, and early interventions to limit its severity are still needed.