title: Hemorrhagic cystitis after allogeneic hematopoietic cell transplantation: risk factors, graft source and survival.
abstract: Although hemorrhagic cystitis (HC) is a common complication of allogeneic hematopoietic cell transplantation (alloHCT), its risk factors and effects on survival are not well known. We evaluated HC in a large cohort (n=1321, 2003-2012) receiving alloHCT from all graft sources, including umbilical cord blood (UCB). We compared HC patients with non-HC (control) patients and examined clinical variables at HC onset and resolution. Of these 1321 patients, 219 (16.6%) developed HC at a median of 22 days after alloHCT. BK viruria was detected in 90% of 109 tested HC patients. Median duration of HC was 27 days. At the time of HC diagnosis, acute GVHD, fever, severe thrombocytopenia and steroid use were more frequent than at the time of HC resolution. In univariate analysis, male sex, age <20 years, myeloablative conditioning with cyclophosphamide and acute GVHD were associated with HC. In multivariate analysis, HC was significantly more common in males and HLA-mismatched UCB graft recipients. Severe grade HC (grade III-IV) was associated with increased treatment-related mortality but not with overall survival at 1 year. HC remains hazardous and therefore better prophylaxis, and early interventions to limit its severity are still needed.
authors.affiliation: Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: L E
authors.initials: LE
authors.lastname: Lunde
authors.affiliation: Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: S
authors.initials: S
authors.lastname: Dasaraju
authors.affiliation: Masonic Cancer Center, Biostatistics and Bioinformatic Core, Fairview Health Services, Minneapolis, MN, USA.
authors.forename: Q
authors.initials: Q
authors.lastname: Cao
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Fairview Health Services, Minneapolis, MN, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Cohn
authors.affiliation: Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: M
authors.initials: M
authors.lastname: Reding
authors.affiliation: Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: N
authors.initials: N
authors.lastname: Bejanyan
authors.affiliation: Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: B
authors.initials: B
authors.lastname: Trottier
authors.affiliation: Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: J
authors.initials: J
authors.lastname: Rogosheske
authors.affiliation: Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: C
authors.initials: C
authors.lastname: Brunstein
authors.affiliation: Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: E
authors.initials: E
authors.lastname: Warlick
authors.affiliation: Division of Infectious Disease, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: J A H
authors.initials: JA
authors.lastname: Young
authors.affiliation: Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Weisdorf
authors.affiliation: Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: C
authors.initials: C
authors.lastname: Ustun
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D064591:Allografts; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000009:adverse effects* / Q000627:therapeutic use; D003556:Cystitis / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D003586:Cytomegalovirus Infections / Q000150:complications; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications* / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D013921:Thrombocytopenia / Q000453:epidemiology / Q000209:etiology; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014775:Virus Activation; D055815:Young Adult
chemical_list: D003520:Cyclophosphamide