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Transplant Toxicities

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

Bone Marrow Transplantation volume 50, pages 1432–1437 (2015)Cite this article

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Abstract

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.

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Acknowledgements

Qing Cao is supported by a grant from the National Cancer Institute CA065493-20.

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Authors and Affiliations

  1. Division of Hematology–Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    L E Lunde, S Dasaraju, M Reding, N Bejanyan, B Trottier, J Rogosheske, C Brunstein, E Warlick, D J Weisdorf & C Ustun

  2. Masonic Cancer Center, Biostatistics and Bioinformatic Core, Fairview Health Services, Minneapolis, MN, USA

    Q Cao

  3. Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Fairview Health Services, Minneapolis, MN, USA

    C S Cohn

  4. Division of Infectious Disease, Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    J A H Young

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  1. L E Lunde
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Lunde, L., Dasaraju, S., Cao, Q. et al. Hemorrhagic cystitis after allogeneic hematopoietic cell transplantation: risk factors, graft source and survival. Bone Marrow Transplant 50, 1432–1437 (2015). https://doi.org/10.1038/bmt.2015.162

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