title: Fibrin glue therapy for severe hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation.
abstract: Hemorrhagic cystitis (HC) occurring after allogeneic transplantation significantly affects quality of life and, in some cases, becomes intractable, increasing the risk of death. To date, its therapy is not established. We used the hemostatic agent fibrin glue (FG) to treat 35 patients with refractory post-transplantation HC. Of 322 adult patients undergoing an allogeneic transplantation for hematological malignancy, 35 developed grade ≥ 2 HC refractory to conventional therapy and were treated with FG, diffusely sprayed on bleeding mucosa by an endoscopic applicator. The cumulative incidence of pain discontinuation and complete remission, defined as regression of all symptoms and absence of hematuria, was 100% at 7 days and 83% ± 7%, respectively, at 50 days from FG application. The 6-month probability of overall survival for all 35 patients and for the 29 in complete remission was 49% ± 8% and 59% ± 9%, respectively. In the matched-pair analysis, the 5-year probability of overall survival for the 35 patients with HC and treated with FG was not statistically different from that of the comparative cohort of 35 patients who did not develop HC (32% ± 9% versus 37% ± 11%, P = not significant). FG therapy is a feasible, effective, repeatable, and affordable procedure for treating grade ≥2 HC after allogeneic transplantation.
authors: Hematology Stem Cell Transplant Transfusion Medicine and Cellular Therapy, Campus Bio-Medico University Hospital, Rome, Italy. Electronic address: m.tirindelli@unicampus.it.
authors: Maria Cristina
authors: MC
authors: Tirindelli
authors: Division of Urology, Campus Bio-Medico University Hospital, Rome, Italy.
authors: Gerardo Paolo
authors: GP
authors: Flammia
authors: Division of Urology, Tor Vergata University Hospital, Rome, Italy.
authors: Pierluigi
authors: P
authors: Bove
authors: Stem Cell Transplant Unit, Department of Hematology, Tor Vergata University, Rome, Italy.
authors: Raffaella
authors: R
authors: Cerretti
authors: Stem Cell Transplant Unit, Department of Hematology, Tor Vergata University, Rome, Italy.
authors: Laura
authors: L
authors: Cudillo
authors: Stem Cell Transplant Unit, Department of Hematology, Tor Vergata University, Rome, Italy.
authors: Gottardo
authors: G
authors: De Angelis
authors: Stem Cell Transplant Unit, Department of Hematology, Tor Vergata University, Rome, Italy.
authors: Alessandra
authors: A
authors: Picardi
authors: Hematology Stem Cell Transplant Transfusion Medicine and Cellular Therapy, Campus Bio-Medico University Hospital, Rome, Italy.
authors: Ombretta
authors: O
authors: Annibali
authors: Hematology Stem Cell Transplant Transfusion Medicine and Cellular Therapy, Campus Bio-Medico University Hospital, Rome, Italy.
authors: Carolina
authors: C
authors: Nobile
authors: Hematology Stem Cell Transplant Transfusion Medicine and Cellular Therapy, Campus Bio-Medico University Hospital, Rome, Italy.
authors: Elisabetta
authors: E
authors: Cerchiara
authors: Division of Hematology and Transplant, Sant'Eugenio Hospital, Rome, Italy.
authors: Teresa
authors: T
authors: Dentamaro
authors: Division of Hematology and Transplant, Sant'Eugenio Hospital, Rome, Italy.
authors: Paolo
authors: P
authors: De Fabritiis
authors: Division of Blood Bank, Department of Immunohematology, Tor Vergata University, Rome, Italy.
authors: Alessandro
authors: A
authors: Lanti
authors: Division of Blood Bank, Department of Immunohematology, Tor Vergata University, Rome, Italy.
authors: Angelo Salvatore
authors: AS
authors: Ferraro
authors: Division of Urology, Campus Bio-Medico University Hospital, Rome, Italy.
authors: Federico
authors: F
authors: Sergi
authors: Stem Cell Transplant Unit, Department of Hematology, Tor Vergata University, Rome, Italy.
authors: Fabio
authors: F
authors: Di Piazza
authors: Hematology Stem Cell Transplant Transfusion Medicine and Cellular Therapy, Campus Bio-Medico University Hospital, Rome, Italy.
authors: Giuseppe
authors: G
authors: Avvisati
authors: Stem Cell Transplant Unit, Department of Hematology, Tor Vergata University, Rome, Italy.
authors: William
authors: W
authors: Arcese
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003556:Cystitis / Q000139:chemically induced / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D003558:Cystoscopy; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D019337:Hematologic Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation; D006470:Hemorrhage / Q000139:chemically induced / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000009:adverse effects; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous
chemical_list: D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D019653:Myeloablative Agonists
keywords: Allogeneic transplantation; Fibrin glue therapy; Hemorrhagic cystitis