title: Hemorrhagic cystitis associated with allogeneic and autologous bone marrow transplantation for malignant neoplasms in adults.
abstract: We investigated the occurrence of hemorrhagic cystitis in 30 consecutive adult patients undergoing bone marrow transplantation (BMT) for hematological and non-hematological malignancies. Ten patients with hematological malignancies received allogeneic BMT, and twenty patients, seven with hematological and 13 with non-hematological malignancies, received autologous BMT. All 30 patients received high-dose cyclophosphamide-containing regimens (120 mg/kg in 16, 200 mg/kg in one, 6000 mg/m2 in 13) as preparative therapies. They all received 2-mercaptoethane sulphonate sodium (mesna) combined with hyperhydration 3 liter/day as prophylaxis for hemorrhagic cystitis. Bladder irrigation was not performed. Overall, five patients (16.7%) developed hemorrhagic cystitis; early-onset (within 48 hours of the end of the high dose chemoradiotherapy) hemorrhagic cystitis occurred in one (3.3%; 95% confidence interval, 0.6-16.7%) and late-onset occurred in four (13.3%; 95% confidence interval, 5.3-29.7%). In three of the four late-onset cases, adenovirus was isolated from the urine specimens at the onset of the hemorrhagic cystitis. Among the 13 patients with non-hematological malignancies receiving autologous BMT, one with recurrent breast cancer developed late-onset hemorrhagic cystitis associated with adenovirus type 11. We conclude the prophylactic measure with mesna and hyperhydration to be effective enough to prevent cyclophosphamide-induced hemorrhagic cystitis of early onset. Some BMT recipients, however, even those with non-hematological malignancies undergoing autologous BMT, develop late-onset hemorrhagic cystitis in which adenovirus is considered a principal causative agent.
authors.affiliation: Department of Medical Oncology, National Cancer Center Hospital, Tokyo.
authors.forename: A
authors.initials: A
authors.lastname: Kohno
authors.forename: K
authors.initials: K
authors.lastname: Takeyama
authors.forename: M
authors.initials: M
authors.lastname: Narabayashi
authors.forename: K
authors.initials: K
authors.lastname: Tamayose
authors.forename: T
authors.initials: T
authors.lastname: Watanabe
authors.forename: I
authors.initials: I
authors.lastname: Adachi
authors.forename: K
authors.initials: K
authors.lastname: Tobisu
authors.forename: K
authors.initials: K
authors.lastname: Tobinai
authors.forename: M
authors.initials: M
authors.lastname: Shimoyama
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003556:Cystitis / Q000209:etiology*; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D014916:Whole-Body Irradiation
chemical_list: D003520:Cyclophosphamide