Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Post-Transplant Events

Clinical effectiveness of hyperbaric oxygen therapy for BK-virus-associated hemorrhagic cystitis after allogeneic bone marrow transplantation

Bone Marrow Transplantation volume 47, pages 1095–1098 (2012)Cite this article

Subjects

Abstract

Late-onset hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (HSCT) has been associated with BK virus (BKV). Antiviral drugs are of limited efficacy and the optimal treatment for HC has not yet been established. Hyperbaric oxygen (HBO) may benefit these patients. We, therefore, retrospectively evaluated the effectiveness of HBO therapy in 16 patients with HC after allogeneic HSCT. All 16 patients had macroscopic hematuria and BKV infection. Patients received 100% oxygen in a hyperbaric chamber at 2.1 atmospheres for 90 min, 5 days per week, with a median 13 treatments (range, 4–84). Fifteen patients (94%) showed complete resolution of hematuria. Median urinary DNA BKV titers declined after HBO (P<0.05). Patients started on HBO earlier after diagnosis of HC responded sooner (P<0.05). HBO was generally well tolerated and proved to be a reliable option for this difficult to manage condition.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Seber A, Shu XO, Defor T, Sencer S, Ramsay N . Risk factors for severe hemorrhagic cystitis following BMT. Bone Marrow Transplant 1999; 23: 35–40.

    Article  CAS  PubMed  Google Scholar 

  2. deVries CR, Freiha FS . Hemorrhagic cystitis: a review. J Urol 1990; 143: 1–9.

    Article  CAS  PubMed  Google Scholar 

  3. Khojasteh NH, Zakerinia M, Ramzi M, Haghshenas M . A new regimen of MESNA (2-mercaptoethanesulfonate) effectively prevents cyclophosphamide-induced hemorrhagic cystitis in bone marrow transplant recipients. Transplant Proc 2000; 32: 596.

    Article  CAS  PubMed  Google Scholar 

  4. Tsuboi K, Kishi K, Ohmachi K, Yasuda Y, Shimizu T, Inoue H et al. Multivariate analysis of risk factors for hemorrhagic cystitis after hematopoietic stem cell transplantation. Bone Marrow Transplant 2003; 32: 903–907.

    Article  CAS  PubMed  Google Scholar 

  5. Decker DB, Karam JA, Wilcox DT . Pediatric hemorrhagic cystitis. J Pediatr Urol 2009; 5: 254–264.

    Article  PubMed  Google Scholar 

  6. Laszlo D, Bosi A, Guidi S, Saccardi R, Vannucchi AM, Lombardini L et al. Prostaglandin E2 bladder instillation for the treatment of hemorrhagic cystitis after allogeneic bone marrow transplantation. Haematologica 1995; 80: 421–425.

    CAS  PubMed  Google Scholar 

  7. Dorticos E, Pavon V, Jaime JC, Reboredo M, Lopez Saura P, Berlanga J et al. Successful application of epidermal growth factor for treatment of hemorrhagic cystitis after bone marrow transplantation. Bone Marrow Transplant 2003; 31: 615–616.

    Article  CAS  PubMed  Google Scholar 

  8. Vela-Ojeda J, Tripp-Villanueva F, Sanchez-Cortes E, Ayala-Sanchez M, Garcia-Ruiz Esparza MA, Rosas-Cabral A et al. Intravesical rhGM-CSF for the treatment of late onset hemorrhagic cystitis after bone marrow transplant. Bone Marrow Transplant 1999; 24: 1307–1310.

    Article  CAS  PubMed  Google Scholar 

  9. Gine E, Rovira M, Real I, Burrel M, Montana J, Carreras E et al. Successful treatment of severe hemorrhagic cystitis after hemopoietic cell transplantation by selective embolization of the vesical arteries. Bone Marrow Transplant 2003; 31: 923–925.

    Article  CAS  PubMed  Google Scholar 

  10. Cesaro S, Brugiolo A, Faraci M, Uderzo C, Rondelli R, Favre C et al. Incidence and treatment of hemorrhagic cystitis in children given hematopoietic stem cell transplantation: a survey from the Italian association of pediatric hematology oncology-bone marrow transplantation group. Bone Marrow Transplant 2003; 32: 925–931.

    Article  CAS  PubMed  Google Scholar 

  11. Etlik O, Tomur A, Deveci S, Piskin I, Pekcan M . Comparison of the uroprotective efficacy of mesna and HBO treatments in cyclophosphamide-induced hemorrhagic cystitis. J Urol 1997; 158: 2296–2299.

    Article  CAS  PubMed  Google Scholar 

  12. Kalayoglu-Besisik S, Abdul-Rahman IS, Erer B, Yenerel MN, Oguz FS, Tunc M et al. Outcome after hyperbaric oxygen treatment for cyclophosphamide-induced refractory hemorrhagic cystitis. J Urol 2003; 170: 922.

    Article  PubMed  Google Scholar 

  13. Furness 3rd PD, Palmer LS, Palmer JS, Capelli-Schellpfeffer M, Cheng EY . Hyperbaric oxygen therapy for pediatric hemorrhagic cystitis. J Urol 1999; 161: 1596–1597.

    Article  PubMed  Google Scholar 

  14. Focosi D, Maggi F, Pistolesi D, Benedetti E, Papineschi F, Galimberti S et al. Hyperbaric oxygen therapy in BKV-associated hemorrhagic cystitis refractory to intravenous and intravesical cidofovir: case report and review of literature. Leuk Res 2009; 33: 556–560.

    Article  CAS  PubMed  Google Scholar 

  15. Bratsas KS, Stephanides AA, Spyropoulos E, Zachariades BP, Androulakakis PA . Hyperbaric oxygen therapy for cyclophosphamide induced refractory hemorrhagic cystitis in a child. J Urol 2004; 172: 679.

    Article  CAS  PubMed  Google Scholar 

  16. Saito S, Kaiho Y, Namina T, Konda R, Satoh M, Ishidoya S et al. A case of severe hemorrhagic cystitis following bone marrow transplantation. Int Urol Nephrol 2004; 36: 349–352.

    Article  PubMed  Google Scholar 

  17. Yoshida T, Kawashima A, Ujike T, Uemura M, Nishimura K, Miyoshi S . Hyperbaric oxygen therapy for radiation-induced hemorrhagic cystitis. Int J Urol 2008; 15: 639–641.

    Article  PubMed  Google Scholar 

  18. Corman JM, McClure D, Pritchett R, Kozlowski P, Hampson NB . Treatment of radiation induced hemorrhagic cystitis with hyperbaric oxygen. J Urol 2003; 169: 2200–2202.

    Article  PubMed  Google Scholar 

  19. Chong KT, Hampson NB, Corman JM . Early hyperbaric oxygen therapy improves outcome for radiation-induced hemorrhagic cystitis. Urology 2005; 65: 649–653.

    Article  PubMed  Google Scholar 

  20. Tibbles PM, Edelsberg JS . Hyperbaric-oxygen therapy. N Engl J Med 1996; 334: 1642–1648.

    Article  CAS  PubMed  Google Scholar 

  21. El-Zimaity M, Saliba R, Chan K, Shahjahan M, Carrasco A, Khorshid O et al. Hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation: donor type matters. Blood 2004; 103: 4674–4680.

    Article  CAS  PubMed  Google Scholar 

  22. National Cancer Institute (NCI). Common Terminology Criteria for Adverse Events v4.0. US Department of Health and Human Services, National Institutes of Health, NCI, 2009.

  23. Rodrigues C, Pinto D, Medeiros R . Molecular epidemiology characterization of the urinary excretion of polyomavirus in healthy individuals from Portugal--a Southern European population. J Med Virol 2007; 79: 1194–1198.

    Article  CAS  PubMed  Google Scholar 

  24. Miodosky M, Abdul-Hai A, Tsirigotis P, Or R, Bitan M, Resnick IB et al. Treatment of post-hematopoietic stem cell transplantation hemorrhagic cystitis with intravesicular sodium hyaluronate. Bone Marrow Transplant 2006; 38: 507–511.

    Article  CAS  PubMed  Google Scholar 

  25. Brugieres L, Hartmann O, Travagli JP, Benhamou E, Pico JL, Valteau D et al. Hemorrhagic cystitis following high-dose chemotherapy and bone marrow transplantation in children with malignancies: incidence, clinical course, and outcome. J Clin Oncol 1989; 7: 194–199.

    Article  CAS  PubMed  Google Scholar 

  26. Haines HL, Laskin BL, Goebel J, Davies SM, Yin HJ, Lawrence J et al. Blood, and not urine, BK viral load predicts renal outcome in children with hemorrhagic cystitis following hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2011; 17: 1512–1519.

    Article  PubMed  Google Scholar 

  27. Erard V, Kim HW, Corey L, Limaye A, Huang ML, Myerson D et al. BK DNA viral load in plasma: evidence for an association with hemorrhagic cystitis in allogeneic hematopoietic cell transplant recipients. Blood 2005; 106: 1130–1132.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Gaziev J, Paba P, Miano R, Germani S, Sodani P, Bove P et al. Late-onset hemorrhagic cystitis in children after hematopoietic stem cell transplantation for thalassemia and sickle cell anemia: a prospective evaluation of polyoma (BK) virus infection and treatment with cidofovir. Biol Blood Marrow Transplant 2010; 16: 662–671.

    Article  CAS  PubMed  Google Scholar 

  29. Leach RM, Rees PJ, Wilmshurst P . Hyperbaric oxygen therapy. BMJ 1998; 317: 1140–1143.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Yildiz S, Aktas S, Cimsit M, Ay H, Togrol E . Seizure incidence in 80 000 patient treatments with hyperbaric oxygen. Aviat Space Environ Med 2004; 75: 992–994.

    PubMed  Google Scholar 

  31. Al-Seraihi A, Ayas M . Hyperbaric oxygen should not be used in the management of hemorrhagic cystitis in patients with Fanconi anemia. Pediatr Blood Cancer 2007; 49: 854–856.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Bone Marrow Transplantation Unit, Portuguese Oncology Institute, Porto, Portugal

    J Savva-Bordalo, C Pinho Vaz, M Sousa, R Branca, F Campilho & A Campos

  2. Hyperbaric Medicine Unit of Hospital Pedro Hispano, Senhora da Hora, Portugal

    R Resende & O Camacho

  3. Department of Virology, Portuguese Oncology Institute, Porto, Portugal

    I Baldaque

Authors
  1. J Savva-Bordalo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C Pinho Vaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Sousa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R Branca
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F Campilho
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R Resende
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. I Baldaque
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. O Camacho
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A Campos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J Savva-Bordalo.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Savva-Bordalo, J., Pinho Vaz, C., Sousa, M. et al. Clinical effectiveness of hyperbaric oxygen therapy for BK-virus-associated hemorrhagic cystitis after allogeneic bone marrow transplantation. Bone Marrow Transplant 47, 1095–1098 (2012). https://doi.org/10.1038/bmt.2011.228

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2011.228

Keywords

This article is cited by

Search

Advanced search

Quick links