Hemorrhagic cystitis following hematopoietic stem cell transplantation: incidence, risk factors and association with CMV reactivation and graft-versus-host disease.
BACKGROUND
The definite pathogenesis of hemorrhagic cystitis (HC) after allogenic hematopoietic stem cell transplantation (allo-HSCT) has not been well elucidated. The role of cytomegalovirus (CMV) reactivation and graft-versus-host disease (GVHD) in the development of HC remains obscure. This study determined the incidence and risk factors for HC after allo-HSCT and analyzed its association with CMV reactivation and GVHD.


METHODS
We retrospectively studied 250 patients at high risk for CMV disease who underwent allo-HSCT all based on busulfan/cyclophosphamide (BU/CY) myloablative regimens. The incidence, etiology, risk factors and clinical management of HC were investigated.


RESULTS
HC developed within 180 days of transplant in 72 patients, with an overall incidence of 28.8% and an incidence of 12.6% in patients with HLA-matched related donors (MRD), 34.38% in those with HLA-matched unrelated donors (MUD), 49.45% in those with mismatched related donors (MMRD). CMV-viremia significantly increased the incidence of later onset HC (LOHC); however, only 9 out of 15 patients with CMV viruria actually developed LOHC. Multiple regression analysis identified grade II - IV acute GVHD (RR = 2.75; 95% CI 1.63 +/- 4.66; P < 0.01) and grafts from MUD or MMRD (RR = 2.60; 95% CI 1.52 +/- 5.20; P < 0.01) as independent risk factors for HC. Event sequence analysis indicated a majority of HC episodes began around GVHD initiation.


CONCLUSIONS
CMV-viremia is a high risk factor for LOHC. Our data also showed a correlation between acute GVHD and HC, which suggested that alloimmunity may be involved in the pathogenesis of HC.
Xu
Lan-ping
LP
Peking University Institute of Hematology, Peking University People's Hospital, Beijing 100044, China.
Zhang
Hong-yu
HY
Huang
Xiao-jun
XJ
Liu
Kai-yan
KY
Liu
Dai-hong
DH
Han
Wei
W
Chen
Huan
H
Chen
Yu-hong
YH
Gao
Zhi-yong
ZY
Zhang
Yao-chen
YC
Lu
Dao-pei
DP
D000328:Adult; D000368:Aged; D003556:Cystitis / Q000453:epidemiology / Q000209:etiology*; D003586:Cytomegalovirus Infections / Q000150:complications*; D006086:Graft vs Host Disease / Q000150:complications*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006474:Hemorrhagic Disorders / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014766:Viremia / Q000150:complications*; D014775:Virus Activation