Late hemorrhagic cystitis after reduced-intensity hematopoietic stem cell transplantation (RIST)

• Published in: Bone marrow transplantation (Basingstoke) Vol. 32; no. 11; pp. 1089 - 1095
• Main Authors: YAMAMOTO, R, KUSUMI, E, UEYAMA, J, TANOSAKI, R, MIYAKOSHI, S, MORI, S, MORINAGA, S, HEIKE, Y, TANIGUCHI, S, MASUO, S, TAKAUE, Y, MUTOU, Y, KAMI, M, YUJI, K, HAMAKI, T, SAITO, A, MURASGIHE, N, HORI, A, KIM, S.-W, MAKIMOTO, A
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.12.2003
• Subjects: Adenoviridae - immunology; Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibodies; Antibodies, Viral - blood; Biological and medical sciences; Blood transfusion; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Busulfan; Busulfan - administration & dosage; Busulfan - toxicity; Calculi; Care and treatment; Causes of; Child; Child, Preschool; Coagulation; Complications and side effects; Cystitis; Cystitis - chemically induced; Cystitis - etiology; Cystitis - virology; Dose-Response Relationship, Drug; Etiology; Female; Graft vs Host Disease - complications; Graft-versus-host reaction; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic stem cells; Hematuria; Hemorrhage; Hemorrhagic cystitis; Hemorrhagic Disorders - chemically induced; Hemorrhagic Disorders - etiology; Hemorrhagic Disorders - virology; Human viral diseases; Humans; Incidence; Infant; Infectious diseases; Leukemia; Male; Malignancy; Medical records; Medical sciences; Middle Aged; Multivariate analysis; Nephrolithiasis; Patients; Retrospective Studies; Risk Factors; Stem cell transplantation; Stem cells; Time Factors; Transfusion; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Viral diseases; Viral diseases of the genital and urinary system; Viruses; Human; Late; Urinary system disease; Adenoviridae; Stem cell; Hematopoietic cell; Homograft; reduced-intensity stem cell transplantation; Urinary tract disease; Non myeloablative treatment; Virus; adenovirus; Graft; Complication; Bladder disease; Hemorrhagic cystitis; Cystitis
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1704261

We reviewed medical records of 256 patients to investigate the frequency and characteristics of hemorrhagic cystitis (HC) associated with reduced-intensity stem cell transplantation (RIST) as opposed to conventional stem cell transplantation (CST); 137 patients underwent CST and 119 RIST. Diagnosis of HC was made based on two or more episodes of sterile, macroscopic hematuria with normal coagulation profiles, without any evidence of renal stones or genitourinary malignancy. Actuarial frequency of HC development in RIST group was 7.6% (9/119), which gave a cumulative annual incidence of 11.7%. In CST group, 13 of 137 patients (9.5%) developed HC, giving an estimated annual incidence of 9.7%. The probability of developing HC was similar between the two groups (P=0.77). The viral etiologies of HC, adenovirus (n=12) and BK virus (n=2), were documented in eight patients after RIST and in six after CST. HC was milder and of a shorter duration, with less blood transfusion requirements, in RIST group than in CST group. A multivariate analysis revealed that HC was associated with antiadenovirus antibody positivity in the recipients, total dose of busulfan, and chronic GVHD. Although HC following RIST is less severe than that following CST, it is still a significant problem.