Hyperbaric Oxygen: an important treatment modality in severe hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation.
OBJECTIVE
Hemorrhagic cystitis (HC) is a generally self-limited complication of hematopoietic stem cell transplantation (HSCT). It may occur in the early or late posttransplant period and can promote sometimes severe morbidity. We analyzed our data regarding HC in allogeneic HSCT patients in order to establish the efficacy of hyperbaric oxygen (HBO) therapy in severe HC and to document the main problems during its use.


METHODS
Between March 1993 and August 2006, 161 patients received allogeneic HSCT. Mesna, hyperhydration and forced diuresis were used as early HC prophylaxis of cyclophosphamide-induced HC. However, HC was diagnosed in 49 of the 161 recipients and 17 of them were considered as severe HC. We analyzed their data retrospectively.


RESULTS
Forced diuresis with hyperhydration (up to 8 L/day) and transfusion support to maintain a platelet count above 30x109/L were sufficient in 10 of the 17 patients with severe HC. Alternative therapies used included intravesical irrigation with formalin and prostaglandin (PG)F2 alpha and HBO, and HBO appeared to be the most useful among them.


CONCLUSIONS
We conclude that HBO offers a noninvasive therapeutic alternative in the management of intractable HC in the HSCT setting.
İstanbul University, İstanbul Medical Faculty, Department of Internal Medicine, Hematology Field, Çapa, İstanbul, Turkey Phone: +90 212 414 20 00-31613, E-mail: mnyenerel@gmail.com.
Mustafa Nuri
MN
Yenerel
Sevgi
S
Kalayoglu-Beşışık
Oktay
O
Perdeci
Nuray
N
Gürses
Murat
M
Tunç
Deniz
D
Sargın