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An expert consensus on prevention, diagnosis, and management of hemorrhagic cystitis in pediatric hematopoietic cell transplantation, on behalf of the Infectious Disease and Hematopoietic Cell Transplant Working groups of Italian Pediatric Hematology Oncology Association (AIEOP)

Abstract

The optimal management of hemorrhagic cystitis (HC) in hematopoietic stem cell transplantation (HCT) is debated, both for early onset HC (EOHC) secondary to chemotherapy toxicity and BK Polyomavirus (BKPyV)-related HC, due to the lack of controlled trials, particularly referred to pediatric setting. Actually, clinical practice is mainly based on guidelines of the European Conference on Infections in Leukemia, 6th edition, which considers both adult and pediatric populations but concludes that, despite much progress in understanding the pathogenesis, epidemiology, and risk factors, this complication still represents a disabling unmet clinical need with limited prophylactic and therapeutic options. Additionally, the Guidelines of the American Society of Clinical Oncology define the management of chemotherapeutic toxicity independently from the patients’ population. A panel of experts belonging to the Hematopoietic Cell Transplant and Infectious Disease Working Group (WG) of Associazione Italiana di Emato-Oncologia Pediatrica (AIEOP) developed a consensus to define the best practices in prevention, diagnosis, and management of HC in pediatric HCT setting.

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Fig. 1: Recommended practices in prevention, diagnosis, and management of HC in pediatric HCT setting.

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GD performed the literature review, summarized the results of the survey and the consensus, conceived and designed the work and the algorithm, and drafted the manuscript. MC performed the urological review and drafted the urological section of the manuscript. MF performed the survey. SC, DP, and MF appointed the panel and supervised the methodology of the consensus. GDO, MC, SC, EO, FV, MC, FS, FC, NM, MCM, KP, ES, FPT, VT, DP, and MF attended the consensus meeting. MC reviewed the urological section of the consensus. SC, EO, AB, FV, MC, FS, FC, NM, MR, MCM, KP, ES, FPT, VT, DP, and MF reviewed the paper and approved the final version.

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Correspondence to Gianluca Dell’Orso.

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Dell’Orso, G., Carlucci, M., Cesaro, S. et al. An expert consensus on prevention, diagnosis, and management of hemorrhagic cystitis in pediatric hematopoietic cell transplantation, on behalf of the Infectious Disease and Hematopoietic Cell Transplant Working groups of Italian Pediatric Hematology Oncology Association (AIEOP). Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02320-4

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