290
Management of Hemorrhagic Cystitis after Allogeneic Hematopoietic Stem Cell Transplantation

Track: Poster Abstracts
Wednesday, February 26, 2014, 6:45 PM-7:45 PM
Longhorn Hall E (Exhibit Level 1) (Gaylord Texan)
Gunhan Gurman, MD , Department of Hematology and Stem Cell Transplantation Unit, Ankara University Faculty of Medicine, Ankara, Turkey
Erden Atilla , Department of Hematology and Stem Cell Transplantation Unit, Ankara University Faculty of Medicine, Ankara, Turkey
Mehmet Ozen , Department of Hematology and Stem Cell Transplantation Unit, Ankara University Faculty of Medicine, Ankara, Turkey
Pinar Kubilay , Department of Internal Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
Gulden Yilmaz , Department of Clinical Microbiology and Infectious Disease, Ankara University Faculty of Medicine, Ankara, Turkey
Mehmet Gunduz , Department of Hematology and Stem Cell Transplantation Unit, Ankara University Faculty of Medicine, Ankara, Turkey
Onder Arslan , Department of Hematology and Stem Cell Transplantation Unit, Ankara University Faculty of Medicine, Ankara, Turkey
Muhit Ozcan, MD , Hematology, Ankara University School of Medicine, Ankara, Turkey
Taner Demirer, MD , Department of Hematology and Stem Cell Transplantation Unit, Ankara University Faculty of Medicine, Ankara, Turkey
Hamdi Akan, MD , Department of Hematology and Stem Cell Transplantation Unit, Ankara University Faculty of Medicine, Ankara, Turkey
Osman Ilhan, MD , Hematology, Ankara University School of Medicine, Ankara, Turkey
Meral Beksac, MD , Hematology, Ankara University School of Medicine, Ankara, Turkey
Pervin Topcuoglu , Department of Hematology and Stem Cell Transplantation Unit, Ankara University Faculty of Medicine, Ankara, Turkey

Hemorrhagic cystitis is one of the important causes of morbidity, which may occur after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Using high dose cyclophosphamide (Cy) as the conditioning regimen is associated with early-onset hemorrhagic cystitis (HC). It is reported that the administration of mesna protects against early-onset HC, caused by Cy. However, late-onset HC may be seen frequently due to viral infections, mostly cytomegalovirus (CMV) and BK/JC virus.

We have retrospectively analyzed 182 patients, who developed HC after allo-HSCT, from 1988 to 2013. Characteristics of the patients were shown in Table 1.

We also present 44 HC patients having detailed data between 2010 and 2013. In these 44 patients median date of the development of HC was calculated as 46 days (4-144). We defined early-onset HC is HC when developed before the 21st day of HSCT, which consists of 7 patients and late-onset HC is HC when developed afterwards of the 21st day of HSCT, which consists of 37 patients. Graft versus Host Disease and HC developed simultaneously in 28 patients.

Patients were initially treated with intravascular hydration and constant bladder irrigation. This treatment was effective within most of the patients. The treatment failed in 11 cases and 5 of them underwent a cystoscopy for evacuation of blood clots. Two patients infected with CMV and 9 patients infected with BK virus have been treated with ganciclovir or cidofovir (±ribavirin), respectively. The treatment has failed in 3 of 9 patients and all of them have died due to accompanying infections. One patient also underwent selective embolisation of vesical artery (Table 2).

As a result, early-onset HC is related to Cy, but late-onset HC is usually associated with BK or CMV infections. HC is generally well treated with i.v hydration and bladder irrigation. In some cases antiviral drugs could be needed. Also, resistant cases may be observed and mortality may be seen due to HC. It is important that the team, who perform allo-HSCT, should be prepared for morbidity due to HC and multidisciplinary treatment algorithm should be designed which includes cooperation with urology and interventional radiology clinics.

Table 1: Characteristics of the Patients

Table 2: Cases with refractory to initial treatment

Disclosures:
Nothing To Disclose
See more of: Poster Session 1: Supportive Care
See more of: Poster Abstracts
<< Previous Presentation | Next Presentation >>