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Continuous IV infusion of MESNA can prevent hemorrhagic cystitis in HSCT and retain MESNA concentration in urine

Bone Marrow Transplantation volume 50, pages 1490–1492 (2015)Cite this article

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Hemorrhagic cystitis (HC) secondary to Cyclophosphamide (CTX) is seen in 5–25% of cases who underwent hematopoietic stem cell transplantation (HSCT), in which acrolein is the major causative agent.1 Late HC was reported in up to 58% of patients receiving myeloablative conditioning for haplo-identical and cord blood HSCT.1 MESNA (2-mercaptoethanesulfonic acid) has a sulfhydryl group that can combine with acrolein and deactivate it.2, 3, 4 The instruction recommends injection of MESNA rapidly, intermittently at the intervals of 0, 4 and 8 h after CTX, with the dose of 150% of the daily dosage of CTX. However, traditional treatments could not provide efficient protection of the bladder. Irrespective of the increasing dosage of MESNA administration, it is hard to maintain an effective concentration for 10–12 h post infusion. We tried to prove whether continuous IV MESNA could decrease the incidence of HC in HSCT or not.

Preliminary prospective study: 66 sequential allogeneic HSCTs who received CTX were randomized into two groups from July 2008 to May 2009 in the Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China. These included 18 ALL, 26 acute nonlymphocytic leukemia (ANLL), 1 mixed acute leukemia (MAL), 19 CML and 2 non-Hodgkin lymphoma (NHL), and among these, 40 were males and 26 were females. The median age was 35 (12–67) years. There were 15/66 HLA-mismatched cases, including 2 vs 2 haplo-HSCTs in both groups, respectively.

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Acknowledgements

We thank the NSFC (30901367 and 31070866), Outstanding Young Teachers’ foundation of SMU (C1031694) and the Natural Science Foundation of Nanfang Hospital (No. 2010037, G2011021). We thank Professor Ning Gan for detecting MESNA.

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Authors and Affiliations

  1. Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Q Jiang, H Huang, Q Liu, J Sun, H Zhou, Z Fan, Y Zhang, F Huang, Y Chai, D Xu, Q Wei, G Yu, X Li, M Dai, N Xu, K Shen, Y Zhou & F Meng

  2. First Clinical Hospital, Southern Medical University, Guangzhou, China

    Y Lu, D Zhou, H Zhao & Q Mai

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Correspondence to Q Jiang or J Sun.

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Jiang, Q., Huang, H., Liu, Q. et al. Continuous IV infusion of MESNA can prevent hemorrhagic cystitis in HSCT and retain MESNA concentration in urine. Bone Marrow Transplant 50, 1490–1492 (2015). https://doi.org/10.1038/bmt.2015.197

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