Hemorrhagic cystitis complicating bone marrow transplantation.
Hemorrhagic cystitis is a potentially serious complication of high-dose cyclophosphamide therapy administered before bone marrow transplantation. As standard practice at our institution, patients who are scheduled to receive a bone marrow transplant are treated prophylactically with forced hydration and bladder irrigation. In an attempt to obviate the inconvenience of bladder irrigation, we conducted a feasibility trial of uroprophylaxis with mesna, which neutralizes the hepatic metabolite of cyclophosphamide that causes hemorrhagic cystitis. Of 97 patients who received standard prophylaxis, 4 had symptomatic hemorrhagic cystitis. In contrast, two of four consecutive patients who received mesna uroprophylaxis before allogeneic bone marrow transplantation had severe hemorrhagic cystitis for at least 2 weeks. Because of this suboptimal result, we resumed the use of bladder irrigation and forced hydration to minimize the risk of hemorrhagic cystitis.
Letendre
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L
Division of Hematology, Mayo Clinic, Rochester, MN 55905.
Hoagland
H C
HC
Gertz
M A
MA
D000046:Academic Medical Centers; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D015984:Causality; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects* / Q000378:metabolism; D003556:Cystitis / Q000139:chemically induced / Q000188:drug therapy* / Q000453:epidemiology; D005240:Feasibility Studies; D005440:Fluid Therapy; D006470:Hemorrhage / Q000139:chemically induced / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D015080:Mesna / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D008910:Minnesota / Q000453:epidemiology
D003520:Cyclophosphamide; D015080:Mesna