Risk Factors of Hemorrhagic Cystitis after Allogeneic Stem Cell Transplantation

Shin, Ho Jin; Lee, Jong Wook; Park, Chi Young; Park, Yoon Hee; Kim, Yoo Jin; Lee, Seok; Min, Chang Ki; Kim, Hee Je; Kim, Dong Wook; Min, Woo Sung; Kim, Chun Choo

Abstract

BACKGROUND: Hemorrhagic cystitis (HC) is one of major causes of morbidity during hematopoietic stem cell transplantation (HSCT), occurring in 7~52% of transplant recipients. We have analyzed the incidence, risk factors, and complications of early (< or = 4 weeks post- transplant) and late-onset HC (4 weeks~100 days post-transplant).
METHODS
To investigate the risk factors and complications of HC, we retrospectively analyzed 378 patients who underwent allogeneic HSCT in Catholic Hematopoietic Stem Cell Transplantation Center between January 1998 and December 2000. Urine specimens of patients with HC were requested for the detection of virus by polymerase chain reaction (PCR) and culture.
RESULTS
HC occurred in 28 patients with an incidence of 7.4%, and 24 among 28 patients (86%) had severe HC (> or = grade II) with urinary obstruction and renal failure (n=2). One patient with grade IV HC died of pneumonia associated with persistent HC. Early and late- onset HC developed at median 9 (2~20) and 55 (31~100) days post-transplant, respectively. Median duration of HC was 16 (3~153) days. Of 23 evaluable patients for study in urine, BK virus was detected in 52% by culture and in 61% by PCR, whereas adenovirus in 18% by PCR. By univariate analysis, disease of aplastic anemia (P=0.03) and non-use of radiation in conditioning regimen (P=0.003) were risk factors for early-onset HC, while the use of busulfan in conditioning regimen (P= 0.02) and grade II-IV acute graft-versus-host disease (GVHD) (P=0.00001) for late-onset HC. By multivariate analysis, use of busulfan (RR=16.62, P=0.002) and aplastic anemia than other disease (RR=9.6, P=0.008) were unfavorable factor for early-onset HC, as only grade II-IV acute GVHD (RR=6, P=0.001) for late- onset HC.
CONCLUSION
More than half of patients with HC developed after allogeneic HSCT were associated with urinary excretion of BK virus. Because of HC is one of the important causes of morbidity after allogeneic HSCT, special attention should be paid to attempting the prevention of HC in patients with high-risk for the development of HC.