title: Risk factors for and prognosis of hemorrhagic cystitis after allogeneic stem cell transplantation: retrospective analysis in a single institution.
abstract: Hemorrhagic cystitis (HC) is a major complication after allogeneic stem cell transplantation (allo-SCT) and can be life threatening. To analyze risk factors and prognosis, we retrospectively reviewed 249 cases receiving allo-SCT in our institution. Median age was 47 years (13-72  years). Disease status at SCT was progressive in 73 cases. Conditioning was myeloablative (MAC) in 146 cases. Acute graft-versus-host disease (aGVHD) grade II-IV treated with prednisolone occurred in 82 cases, and cytomegalovirus (CMV) was reactivated in 91 cases. HC was reported in  47 cases at a median of 35 days (7-469 days) after SCT, and 34 (72.3%) cases recovered after a median of 19.5 days (2-252 days). In univariate analysis, the identified risk factors for HC included age over 45 years, progressive disease status, MAC, aGVHD treated with prednisolone,  and CMV reactivation. In multivariate analysis, older age, MAC, and CMV remained independent predictors (hazard ratios: 2.35, 3.50, and 2.87). In patients with severe HC, percentage recovery was lower (3 in 13 cases; 23.1%) and the median duration was longer (54 days) than in those with moderate  HC (31 in 36 cases; 86.1%, 17 days, P < 0.01). Treatment-related mortality was also higher (59.1%, P = 0.03) and overall survival was poorer (16.7%, P < 0.01) at 1 year after SCT. Prospective studies should be started considering prophylactic  antiviral administration in high-risk patients such as those identified in this study.
authors.affiliation: Department of Haematology/Oncology, Kurashiki Central Hospital, Okayama, Japan. ysykrai@kuhp.kyoto-u.ac.jp
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Arai
authors.forename: Takeshi
authors.initials: T
authors.lastname: Maeda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugiura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Matsui
authors.forename: Tomoyasu
authors.initials: T
authors.lastname: Jo
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ueda
authors.forename: Kazuya
authors.initials: K
authors.lastname: Okada
authors.forename: Takehito
authors.initials: T
authors.lastname: Kawata
authors.forename: Tatsuhito
authors.initials: T
authors.lastname: Onishi
authors.forename: Chisato
authors.initials: C
authors.lastname: Mizutani
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Ueda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003556:Cystitis / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D014184:Transplantation, Homologous; D055815:Young Adult