title: Hemorrhagic cystitis in children treated with alkylating agent cyclophosphamide: The experience of a medical center in Taiwan.
abstract: OBJECTIVE
  Hemorrhagic cystitis is a common complication with chemotherapeutic alkylating agents. We investigated the possible prognostic factors of cyclophosphamide-induced hemorrhagic cystitis in children.
  
  
  METHODS
  Medical records of children (< 18 years old) with cyclophosphamide-related hemorrhagic cystitis were collected retrospectively from January 2000 to December 2010 in a tertiary care center. We also prospectively enrolled children (< 18 years old) with cyclophosphamide treatment.
  
  
  RESULTS
  The retrospective study consisted of 23 patients whose median age was 11 years. The median day of onset time was 1 day after cyclophosphamide usage. The hemato-oncological diseases included acute leukemia (39.1%), lymphoma (13%), blastoma (13%), sarcoma (13%), aplastic anemia (13%), and others (8.7%). Patients who received bone marrow transplantation (BMT) had significantly longer duration of hemorrhagic cystitis than those who did not receive BMT (p < 0.05). Serum uric acid, checked prior to and after the onset of hemorrhage cystitis, was significantly lower after the development of hemorrhagic cystitis (p < 0.05). In the prospective study, 11 children were enrolled with a median age of 5 years. The urinary nitrite/nitrate and 8-iso-prostaglandin F2α levels increased significantly after cyclophosphamide usage (p < 0.05).
  
  
  CONCLUSIONS
  Alteration serum uric acid level and BMT could be indicators for severe hemorrhagic cystitis. The elevated levels of urinary nitrite/nitrate and 8-iso-prostaglandin F2α may indicate the essential roles played by nitric oxide syntheses and reactive oxidative stress in cyclophosphamide-induced hemorrhagic cystitis. These findings may help clinicians formulate a better strategy for treating cyclophosphamide-induced hemorrhagic cystitis.
authors.affiliation: Department of Pediatrics, Division of Critical Care Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Ching-Chia
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Department of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Te-I
authors.initials: TI
authors.lastname: Weng
authors.affiliation: Department of Pediatrics, Division of Critical Care Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Meng-Yao
authors.initials: MY
authors.lastname: Lu
authors.affiliation: Department of Orthopaedics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Rong-Sen
authors.initials: RS
authors.lastname: Yang
authors.affiliation: Department of Pediatrics, Division of Critical Care Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Kai-Hsin
authors.initials: KH
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Division of Critical Care Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Mei-Hwan
authors.initials: MH
authors.lastname: Wu
authors.affiliation: Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: shinghwaliu@ntu.edu.tw.
authors.forename: Shing-Hwa
authors.initials: SH
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000009:adverse effects*; D003556:Cystitis / Q000139:chemically induced*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D012189:Retrospective Studies; D013624:Taiwan; D062606:Tertiary Care Centers; D014527:Uric Acid / Q000097:blood*; D001743:Urinary Bladder / Q000187:drug effects*
chemical_list: D018906:Antineoplastic Agents, Alkylating; D014527:Uric Acid; D003520:Cyclophosphamide
keywords: cyclophosphamide; hemorrhagic cystitis; nitric oxide; uric acid