Cystectomy for severe hemorrhagic cystitis in allogeneic stem cell transplant recipients.
BACKGROUND
Hemorrhagic cystitis (HC) is a common complication following allogeneic stem cell transplantation (SCT). In rare cases, it can be severe, inducing kidney failure and sepsis, and become life-threatening.


METHODS
We report three cases of severe HC in stem cell transplant recipients. Risk factors and the management of these patients were studied, as well as severe HC cases reported in the literature.


RESULTS
All three patients received high-dose cyclophosphamide in addition to total body irradiation or busulfan in their preparative regimen. They underwent allogeneic SCT, one of them from unrelated cord blood. BK viruria was detected in two cases at the onset of hematuria. HC lasted for more than 3 months, resulting in urinary tract obstruction and sepsis. Ultimately, cystectomy was the last therapeutic procedure available to treat this life-threatening complication.


CONCLUSIONS
We describe three patients, among a total of more than 1300 patients treated in our unit by allogeneic bone marrow transplantation, in whom HC was severe and long lasting enough to require cystectomy as a life-saving procedure.
Garderet
L
L
Department of Bone Marrow Transplantation, Saint Louis Hospital, Paris, France.
Bittencourt
H
H
Sebe
P
P
Kaliski
A
A
Claisse
J P
JP
Espérou
H
H
Ribaud
P
P
Estrade
V
V
Gluckman
E
E
Gattegno
B
B
D000293:Adolescent; D000328:Adult; D001739:BK Virus / Q000302:isolation & purification / Q000472:pathogenicity; D003520:Cyclophosphamide / Q000009:adverse effects; D015653:Cystectomy; D003556:Cystitis / Q000209:etiology* / Q000601:surgery*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007938:Leukemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014184:Transplantation, Homologous
D003520:Cyclophosphamide