Clinical Analysis of Hemorrhagic Cystitis after Allogeneic Hematopoietic Stem Cell Transplantation

Objective: To analyze the risk factors and survival of the patients with hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (HSCT).Methods: Propensity score Matching was conducted for HC patients among 523 patients who received HSCT in Hematopoietic Stem Cell Transplantation Center, Institute of Hematology & Blood Disease Hospital, Chinese Academy of Medical Sciences from August 2016 to August 2019. Non-HC patients were selected with a ratio of 1:2 (HC: non-HC) and then statistically analyzed with SPSS 22.0. Results:130 HC patients and 233 non-HC patients were included in the study. There were HC of grade I-II in 114/130 cases(87.69%) and of grade III-IV in 16/130 (12.31%), The median time of onset was 33 days after HSCT(range 3-339 days).Univariate analysis indicated that HC occurrence were associated with the source of stem cells, infusion CD34+ cells count, morphologic remission before transplantation, HLA matching, urinary BK virus load and the drug of Bu in conditioning regimens. Multiple regression analysis showed that morphologic remission before transplantation, HLA matching and infusion CD34+ cells count were associated with HC. K-M survival analysis showed that the 1-year survival rate of HC and non-HC was 91.8% vs 86.3%, and the 2-year survival rate was 52.5% vs 50.6%, respectively, showing no statistical difference. ROC curve showed that when the level of BKV is higher than 5×10⁸ copies /ml, the risk of HC would increase.

Conclusion: HC was associated with morphologic remission before transplantation, HLA matching and infusion CD34+ cells count. There was no significant difference in survival between HC and Non-HC groups. the level of urinary BKV load higher than 5×10⁸ copies /ml may cause hemorrhagic cystitis symptoms.

Key words: hemorrhagic cystitis; Allogeneic hematopoietic stem cell transplantation; Risk factors; Prognosis