Late Onset Hemorrhagic Cystitis (LOHC) Following Stem Cell Transplant (SCT): Risk Factors and Outcomes.

Background. Hemorrhagic cystitis (HC) following stem cell transplant (SCT) is classified into two types, based on causes and time of appearance. Early-onset HC occurs within 48 hours of preparative regimen, and is thought to be a complication of high-dose chemotherapy containing preparative regimen. Late-onset HC occurs beyond 48 hours from the preparative regimen and has been reported to be associated with viral infections.

Goals. To establish risk factors for predicting LOHC and the impact on the outcomes following SCT.

Subjects and methods. We retrospectively analyzed the clinical records of 41 patients who underwent SCT from June 2002-June 2004, the median age 54 years (range 20–74), including 28 males and 13 females. The patients had the following diagnosis: AML/MDS=15, ALL=4, CML=2, NHD/HD=14, MM=4, solid tumor=1, and AA=1. Twenty-two patients received allogeneic transplants (matched sibling-10, matched unrelated-2, cord blood -10), and 19 patients underwent autologous SCT. Conditioning regimens included the following: BEAM=8, BU+CY±Thiotepa=17, TBI+CY±others=4, Melphalan±Fludara=12. Sixteen patients were considered to have poor risk disease (those beyond first complete remission or in relapse) and 25 patients had good risk disease. LOHC was defined as: RBCs in the urine without any trauma and persistence of >7 days. All patients who developed LO HC were tested for BK virus, CMV, and adenovirus in the urine and blood, which were measured by a real-time PCR assay.

Results. LOHC was detected in 11 patients (26.8%), 8 of which had BK viruria. median of 23 days (range 13–60 days), None of these patients were detected to have CMV or adenovirus. Nine patients (90%) that received cord blood SCT developed LO HC, while only two patients (6.4%) who did not have cord blood SCT developed LO HC (P=0.0001). Ten patients (58.8%) who had BU+CY±Thiotepa developed HC compared to one patient (4.2%) who did not have the same regimen and developed LO HC (P=0.0002). Nine patients (56.2%) who had poor risk disease developed LOHC, while two patients (8%) who had good risk disease developed LOHC (P=0.001). Eight patients (72.7%) who developed LOHC died compared to only six patients (20%) who did not develop LOHC and died (P=0.003). Among the 28 males, 10 patients developed LOHC, compared to only one female patient who developed LOHC (P=0.126).

Conclusion. Three predisposing factors were identified for the development of LOHC: cord blood transplant (P=0.0001), Busulphan use for pre-transplant conditioning (P=0.0002), and poor risk group characteristics (P=0.001). The mortality rate was significantly higher among patients who developed LOHC.