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Hemorrhagic Cystitis Following Hematopoietic Stem Cell Transplants in Children: Single Center Experience
Methods: We performed a retrospective study on 900 pediatric patients who received HSCT after myeloablative or reduced intensity conditioning during 1992 – 2011 in our center. In all, sixty patients (43 male &17 female) developed HC: early in 35 patients and late in 25 patients. Median age of patients was 9.19years (range: 2-15). Major thaassemia (45%) and ALL (18.30%) were most common cause of transplantation. Patients received transplant from matched donor (n=45), 2 locus mismatched (n=8) and HLA-haploidentical (n=7). The source of stem cell were peripheral blood (n=40), bone marrow (n=15) and cord blood (n=5). Majority of patient (83.3%) received BU/CY conditioning regiment.
Results: The prevalence of HC was 6.7% in our patients who all of them had received allogenic HSCT. 4 patients had pervious history of HC. Acute graft versus host disease (GvHD) occurred in 46(76.7%) patients. There was no significant correlation between the grade of acute GvHD and severity of HC (P-value>0.05). By quantitative PCR, a viral etiology for one or more viruses was found in 40 cases (CMV, HSV& BK). HC was managed with supportive care (blood and platelet transfusion, hydration and irrigation) in all patients. 4 of the patients required surgical interventions and cystectomy. 4 years Overall survival of patients was 56%. Main cause of death were sever HC (n=11) and disease relapse (n=9).
Conclusion: HC is caused by the interaction of several conditions such as donor type and preparative regimen intensity. This study shows that young age correlated with a lower incidence of severe HC. A prospective study is necessary to clarify the association between clinical factors such as age in the development of severe HC following HSCT in children.