title: A retrospective study of treatment and prophylaxis of ifosfamide-induced hemorrhagic cystitis in pediatric and adolescent and young adult (AYA) patients with solid tumors.
abstract: OBJECTIVE
  Ifosfamide (IFO) is considered an essential drug for the treatment of pediatric, adolescent and young adult patients with solid tumors. Hemorrhagic cystitis (HC) is one of the dose-limiting toxicity of IFO. However, there are insufficient evidence for risk factor and supportive care of IFO-induced HC.
  
  
  METHODS
  In this retrospective study, patients (<30-year-old) with malignant solid tumors who had been treated with IFO-based chemotherapy, were categorized according to the presence or absence of HC, and were analyzed possible risk factors for IFO-induced HC. In our institution, continuous hydration to increase urine output and intravenous 2-mercaptethane sulfonate (mesna) are used for prophylaxis of IFO-induced HC. Increased hydration and dosage of mesna are administered to patients who develop IFO-induced HC; they also receive 24-h continuous infusion of mesna in subsequent treatment cycles.
  
  
  RESULTS
  Nine treatment regimens were used in the 70 study patients. The range of daily IFO dosage was 1.2-3.0 g/m(2). HC occurred in 14/425 IFO-based chemotherapy cycles (3.3%). The daily IFO dosages (mean ± SD) in patients with or without HC were 2.23 ± 0.58 g/m(2) and 1.85 ± 0.50 g/m(2), respectively (P = 0.006). Only one of the nine patients who developed IFO-induced HC had experienced this complication in a subsequent cycle of treatment.
  
  
  CONCLUSIONS
  The incidence of IFO-induced HC may be associated with the dosage of IFO. When administering IFO higher than 2.0 g/m(2)/day, the volume of hydration, dosage of mesna and duration of mesna infusion should be increased to prevent HC.
authors.affiliation: Department of Pharmacy, National Cancer Center Hospital, Tokyo Faculty of Pharmaceutical Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa yoshsait@ncc.go.jp.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kumamoto
authors.affiliation: Department of Pharmacy, National Cancer Center Hospital, Tokyo.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Makino
authors.affiliation: Faculty of Pharmaceutical Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa.
authors.forename: Ikumi
authors.initials: I
authors.lastname: Tamai
authors.affiliation: Department of Pediatric Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Chitose
authors.initials: C
authors.lastname: Ogawa
authors.affiliation: Department of Pharmacy, National Cancer Center Hospital, Tokyo.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Terakado
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003556:Cystitis / Q000453:epidemiology / Q000209:etiology*; D004334:Drug Administration Schedule; D005260:Female; D006470:Hemorrhage; D006801:Humans; D007069:Ifosfamide / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D007223:Infant; D008297:Male; D015080:Mesna / Q000627:therapeutic use; D009369:Neoplasms / Q000188:drug therapy*; D020011:Protective Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D020011:Protective Agents; D015080:Mesna; D007069:Ifosfamide
keywords: adolescent and young adult (AYA) patients; hemorrhagic cystitis; hydration; ifosfamide; mesna; pediatric patients