title: Intravesical rhGM-CSF for the treatment of late onset hemorrhagic cystitis after bone marrow transplant.
abstract: In the present study, we assessed the clinical effect of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) in the treatment of refractory, grade III-IV hemorrhagic cystitis (HC) in six patients who underwent bone marrow transplantation (BMT). These were four males and two females, aged 24-40 years (median age 30.5 years). All received allogeneic BMT from HLA-identical siblings after preparation with busulfan-cyclophosphamide. HC was evident 24. 5 days (range 15-33 days) after BMT. Median duration of HC before treatment was 5 days (range 4-9 days). Treatment consisted of intravesical instillation of rhGM-CSF (400 microg) for 3 consecutive days. A complete response was observed in three patients, the other three showed a partial response. Median time to achieve response was 36 h (range 0.2-72 h). Hematuria was controlled after the first (two patients), second (two patients) or third (two patients) dose of intravesical rhGM-CSF. Patients were discharged from the hospital 10. 5 days (range 3-41 days) after treatment. All patients have been followed for up to 10 months and none have required further treatment. No systemic or bladder side-effects have been observed. Although our results indicate that intravesical instillation of rhGM-CSF is effective in the treatment of HC, a phase II clinical trial, including a larger series of patients, is needed.
authors.affiliation: Servicio de Hematología del Hospital de Especialidades, Centro Médico Nacional La Raza, IMSS, México, DF México.
authors.forename: J
authors.initials: J
authors.lastname: Vela-Ojeda
authors.forename: F
authors.initials: F
authors.lastname: Tripp-Villanueva
authors.forename: E
authors.initials: E
authors.lastname: Sanchez-Cortés
authors.forename: M
authors.initials: M
authors.lastname: Ayala-Sanchez
authors.forename: M A
authors.initials: MA
authors.lastname: García-Ruiz Esparza
authors.forename: A
authors.initials: A
authors.lastname: Rosas-Cabral
authors.forename: J
authors.initials: J
authors.lastname: Gonzalez-Llaven
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D003556:Cystitis / Q000188:drug therapy* / Q000209:etiology; D018572:Disease-Free Survival; D017707:Erythrocyte Transfusion; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage*; D006417:Hematuria / Q000150:complications; D006470:Hemorrhage; D006801:Humans; D007938:Leukemia / Q000150:complications; D008297:Male; D011994:Recombinant Proteins / Q000008:administration & dosage; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000150:complications
chemical_list: D011994:Recombinant Proteins; D016178:Granulocyte-Macrophage Colony-Stimulating Factor