Hemorrhagic cystitis following bone marrow transplantation

Abstract EN

It is known that high dose cyclophosphamide (cycloph), through its metabolite acrolein can cause hemorrhagic cystitis (HC) which can be a serious and life threatening complication.

We decided to perform an analysis of risk factors for the development of HC in patients receiving cycloph as part of their conditioning regimen for bone marrow transplantation (BMT).

A total of 45 patients (25 males &.

20 females) underwent BMT as treatment for hematological and malignant diseases.

The median age was 12 years (range 2-43).

The conditioning regimen was either cycloph 120 mg/kg over two days and total body irradiation 1440 mg/kg over four days, or cycloph 200 mg/kg over four days and Busulfan, 14 mg/kg over four days.

The uroprotective measures taken included Mesna 160% of the cycloph dose with fluid hydration (120 ml/m2/hr) over two days.

The overall incidence of hematuria was 60% (31% microscopic and 29% gross hematuria) and the median onset was at day three post start of chemotheraphy (range 1-33 days).

We found no difference between the two groups (HC or non-HC) in respect of age, conditioning regimen, frequency of bladder emptying and fluid input (p values > 0.05).

The only significant difference was in the mean urine output; 3200 ml/m2/day (133 ml/m2/hr) for HC and 3560 ml/m2/day (150 ml/m2/hr) for non HC (p values = 0.02).

We advise prolonging the IV fluid hydration to a total of three days and maintaining a high urine output more than 3560 ml/m2 /day (150 ml/m2 /hr) during cycloph administration.