Incidence and risk factors for hemorrhagic cystitis in unmanipulated haploidentical transplant recipients.
BACKGROUND
Hemorrhagic cystitis (HC) is a common complication after hematopoietic allogeneic stem cell transplantation (HSCT) associated with intensity of the conditioning regimen, cyclophosphamide (Cy) therapy, and BK polyomavirus (BKPyV) infection.


METHODS
We analyzed 33 consecutive haploidentical (haplo) HSCT recipients transplanted for hematologic diseases. Eleven patients had a previous transplant. Median follow-up was 11 months. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine + mycophenolate mofetil and post-HSCT Cy.


RESULTS
Thirty-two of 33 patients achieved neutrophil recovery. Cumulative incidence (CI) of platelet recovery was 65%. CI grade II-IV acute GVHD was 44%. Twenty patients developed HC in a median time of 38 days. CI of HC at day 180 was 62%. BKPyV was positive in blood and urine of 91% of patients at HC onset. HC resolved in 18/20 patients. Factors associated with HC were previous transplant (P = 0.01) and occurrence of cytomegalovirus reactivation before HC (P = 0.05). Grade II-IV acute GVHD was not associated with HC (P = 0.62). CI of day 180 viral infections was 73%. Two-year overall survival (OS) was 50%; HC did not impact OS (P = 0.29).


CONCLUSIONS
The incidence of HC after haplo with post-HSCT Cy is high and is associated with morbidity, especially in high-risk patients such as those with a previous transplant history and with impaired immune reconstitution.
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.|INSERM, UMRs 938, Paris, France.
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Ruggeri
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.|Service d'Hématologie, CHU Nancy, Nancy, France.
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Roth-Guepin
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.|Ematologia, Università Federico II di Napoli, Naples, Italy.
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Battipaglia
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
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Mamez
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.|INSERM, UMRs 938, Paris, France.
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Malard
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
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Gomez
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.|INSERM, UMRs 938, Paris, France.|Université Pierre & Marie Curie, Paris, France.
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Brissot
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
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Belhocine
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
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Vekhoff
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
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Lapusan
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
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Isnard
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
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Legrand
Service de Virologie, Hôpital Saint Antoine, AP-HP, Paris, France.
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Gozlan
Service de Virologie, Hôpitaux Universitaires Pitié-Salpêtrière, AP-HP, Paris, France.
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Boutolleau
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.
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Ledraa
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.|Université Pierre & Marie Curie, Paris, France.
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Labopin
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.|INSERM, UMRs 938, Paris, France.
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Rubio
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.|INSERM, UMRs 938, Paris, France.|Université Pierre & Marie Curie, Paris, France.
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Mohty
D000293:Adolescent; D000328:Adult; D000368:Aged; D003556:Cystitis / Q000209:etiology*; D006086:Graft vs Host Disease / Q000517:prevention & control; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006470:Hemorrhage; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D015994:Incidence; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
D007166:Immunosuppressive Agents
BK virus; hemorrhagic cystitis; post-transplant cyclophosphamide; unmanipulated haploidentical transplant