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Use of high-dose mesna and hyperhydration leads to lower incidence of hemorrhagic cystitis after posttransplant cyclophosphamide-based allogeneic transplantation

Bone Marrow Transplantation volume 56, pages 2464–2470 (2021)Cite this article

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Abstract

Currently, there is no consensus on best practices to prevent hemorrhagic cystitis (HC) in patients receiving posttransplant cyclophosphamide (PTCy). We retrospectively reviewed 194 patients undergoing their first hematopoietic cell transplant (HCT) who received PTCy from 2014 to 2018 to describe the incidence and severity of HC, identify potential risk factors, and impact of HC on HCT outcomes. Standard HC prophylaxis was hyperhydration with forced diuresis and mesna at 320% the daily dose of PTCy. Incidence of HC was 31.4% at day +100 of HCT. Median onset of HC was 12 days with 11.5% grade 3 HC and no Grade 4 HC. Patients with chemical HC experienced earlier onset (7 days vs. 34 days, p < 0.001) with a shorter median resolution time (5 days vs. 14 days, p = 0.001) when compared to BK-associated HC. In multivariate analysis, age above 60 years (HR 4.16, p = 0.006) and myeloablative conditioning (HR 2.44, p = 0.054) were associated with higher risk for HC, but overall, HC did not affect nonrelapse mortality or overall survival. In conclusion, hyperhydration with forced diuresis combined with aggressive mesna dosing is an effective strategy in preventing severe PTCy-associated HC, subsequently preventing any negative impact on transplant outcome.

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Acknowledgements

The authors thank the City of Hope staff and nurses, as well as the patients and their families, without whom this work would not have been possible.

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  1. These authors contributed equally: Stephanie Mac, Dat Ngo

Authors and Affiliations

  1. Department of Pharmacy, City of Hope, Duarte, CA, USA

    Stephanie Mac, Dat Ngo & Jason Chen

  2. Department of Information Sciences, City of Hope, Duarte, CA, USA

    Dongyun Yang

  3. Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA

    Haris Ali, Shukaib Arslan, Amandeep Salhotra, Thai Cao, Ibrahim Aldoss, Paul Koller, Andrew Artz, Ahmed Aribi, Karamjeet Sandhu, Vinod Pullarkat, Anthony Stein, Guido Marcucci, Stephen J. Forman, Ryotaro Nakamura & Monzr M. Al Malki

  4. Department of Infectious Diseases, City of Hope, Duarte, CA, USA

    Sanjeet Dadwal

  5. Department of Pediatrics, City of Hope, Duarte, CA, USA

    Nicole Karras

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Correspondence to Monzr M. Al Malki.

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Mac, S., Ngo, D., Yang, D. et al. Use of high-dose mesna and hyperhydration leads to lower incidence of hemorrhagic cystitis after posttransplant cyclophosphamide-based allogeneic transplantation. Bone Marrow Transplant 56, 2464–2470 (2021). https://doi.org/10.1038/s41409-021-01364-0

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