Summary:Hemorrhagic cystitis (HC) is a major cause of morbidity after allogeneic bone marrow transplantation (BMT). Many therapies have been investigated to prevent or treat HC, but effective treatment for HC is still limited. While the efficacy of hyperbaric oxygen therapy has been established for HC due to chemotherapy and/or radiation therapy, its role in HC occurring after allogeneic BMT has yet to be defined. We report two cases of life-threatening late-onset HC after allogeneic BMT in children, which resolved after treatment with hyperbaric oxygen. Bone Marrow Transplantation (2001) 27, 1315-1317. Keywords: hemorrhagic cystitis; hyperbaric oxygen; allogeneic bone marrow transplantation; children Hemorrhagic cystitis (HC) is a major complication following hematopoietic stem cell transplantation. Severe cystitis has been reported to occur in about 5% of bone marrow transplant (BMT) patients. Allogeneic BMT, grade II-IV graft-versus-host disease (GVHD), use of busulfan (Bu), age at transplantation and adenovirus infection increase the risk of severe HC. 1 Many therapeutic approaches have been tried to control pain and bleeding due to HC; despite this, HC can lead to bladder tamponade requiring surgical intervention, and can contribute to death. Hyperbaric oxygen (HBO) therapy has been used extensively in hypoxic tissue in an attempt to stimulate angiogenesis and prompt healing. HBO has been used successfully in the treatment of radiation or cyclophosphamide (CY)-induced HC. 2,3 This is the first report in patients with intractable HC after allogeneic BMT who were controlled by HBO. Case histories Case 1An eight-year-old boy with acute lymphocytic leukemia in third remission underwent BMT from an HLA-matched unrelated donor in June 1998. He received a conditioning regimen of Bu 4 mg/kg/day for 4 days, CY 60 mg/kg/day for 2 days, and etoposide 60 mg/kg/day for 1 day. Cyclosporine A (CsA) and prednisolone were administered for GVHD prophylaxis. The clinical course after BMT is shown in Figure 1. By the fifth week after BMT, trilineage engraftment was confirmed. The patient did not develop acute GVHD. At day +4 he had developed dysuria, suprapubic pain and macrohematuria. On day +70 he developed gross hematuria with clots and an abundant residue of bladder mucus. Adenovirus was not cultured from the urine, and HC was not attributed to polyomavirus infection because characteristic morphologic changes in the urinary sediment were not seen in conjunction with the urine culture being negative for other pathogens. During the next 9 weeks, gross hematuria continued, and the patient required seven transfusions of packed red blood cells and 33 transfusion of platelets. Despite conservative treatment with continuous bladder irrigation and intravesicular maalox and prostaglandin E1 (PGE1), he developed bladder tamponade on days +78 and +118 after BMT requiring emergency cystostomy and evacuation of hematomas. Post-renal failure developed, and he was referred for HBO therapy after bilateral tympanostomies. The patient was ...

BACKGROUND: Leukoreduced blood components have been widely implemented to prevent transfusiontransmitted cytomegalovirus (TT-CMV) in transplantation. Recent progress in leukoreduction technology has helped reduce the risk of TT-CMV in hematopoietic stem cell transplantation; however, its efficacy in umbilical cord blood transplantation (CBT) has not been systematically studied. STUDY DESIGN AND METHODS:We retrospectively analyzed the incidence of CMV infection in patients treated with CBT who received prestorage leukoreduced, CMV-unselected blood components between 2007 and 2017 in a single Japanese pediatric center. Patients were monitored for CMV antigenemia at least once weekly. RESULTS:In total, 71 patients treated with CBT were identified. Two patients were excluded because of unknown CMV serostatus or early death after CBT. Of the remaining 69 patients, 24 developed CMV antigenemia. Among them, 3 received granulocyte transfusions (3 of 3; 100%), 2 were infants with severe combined immunodeficiency who had been infected with CMV before CBT (2 of 2; 100%), and 19 were CMVseropositive patients (19 of 23, 82.6%). Conversely, of the remaining 45 patients in whom CMV antigenemia did not develop, 41 were seronegative (0 of 41; 0%) and were transfused with a total of 925 leukoreduced, CMVunselected blood components. Among the 41 patients, 9 (22%) received in vivo T-cell depletion with antithymocyte globulin. None of the patients in the seronegative group has subsequently shown evidence of CMV infection or developed CMV disease. CONCLUSION: Using prestorage leukoreduction, nocases of CMV infection were detected in seronegative CBT patients. Our findings showed the safety of leukoreduction in preventing TT-CMV in this patient group. ABBREVIATIONS: CB = cord blood; CBT = cord blood transplantation; CLIA = chemiluminescent immunoassay; CMV = cytomegalovirus; GTXs = granulocyte transfusions; GVHD = graftversus-host disease; HHV = human herpes virus; HLA = human leukocyte antigen; HSCT = hematopoietic stem cell transplantation; LR = leukoreduction; PCR = polymerase chain reaction; SCID = severe combined immunodeficiency; TT-CMV = transfusiontransmitted cytomegalovirus.From the

Background: Allergic transfusion reactions (ATRs) manifest frequently as transfusion reactions, and their onset may be related to a patient's allergic predisposition. Moreover, although pediatric patients with hematological/oncological disease are more susceptible to ATRs, the relationship between allergic predisposition and ATRs remains to be fully clarified. Study Design and Methods: Patients who were diagnosed with pediatric hematological/oncological disease and received transfusion at the study institutions were included. We determined patient background information related to their allergy history, measured the levels of allergen-specific immunoglobulin E (IgE) using sera obtained on diagnosis, and analyzed their associations with ATR onset.Results: Of the 363 patients analyzed, 144 developed ATRs. Multivariate analysis identified cases with high basophils in the peripheral blood, and Dermatophagoides pteronyssinus-and egg white-specific IgEs were involved in the development of ATR in all age groups. Meanwhile, a history of food allergies, and positivity for Japanese cypress-and D. pteronyssinus-specific IgEs were risk factors for developing ATRs in the <5 years age group. Moreover, patients aged 5-<10 years with a history of asthma, allergic rhinitis, pollinosis, or atopic dermatitis, and those aged ≥10 years with positivity for dog danderspecific IgE were at risk for developing ATRs. Conclusion:The allergic constitution of patients plays a role in ATR onset even in pediatric hematological/oncological diseases. Therefore, advance confirmation of a patient's allergic constitution may partly predict the onset of ATRs. However, since multiple allergic predispositions within complex mechanisms may be involved in the onset of ATRs, further verification is required.

Two series of trends in negative pressure with cavitation in water were observed by the Berthelot method using single- and poly-crystalline molybdenum tubes sealed with single-crystalline copper plugs by repeating runs of temperature cycles at rates of 70-100 cycles/day between 50 and 98 °C, where a run means successive cycles with the same water. The first series were observed while both tubes and plugs were pre-degassed, and the second after exposure of the both tubes alone to N2 gas. The all-single-crystalline-metal tube in the pre-degassed state yielded a steady increase from -120 to -140 bar (1 bar≃0.1 MPa) in the initial 1250 cycles. After its gas exposure the single-crystalline tube yielded a trend having an initial peak of -160 bar followed by a steady fall to -110 bar in the first run, and recovered the capability of yielding a trend levelling around -165 bar throughout the sixth run after a total of about 5000 cycles. In any run cavitation occurred within about ±12 bar around the current average. In contrast, the poly-crystalline Mo tube in the pre-degassed state yielded widely-scattered negative pressures; the higher envelope increased gradually to -140 bar while lower envelope remained to be about -40 bar in the second run to a total of initial 4000 cycles. After similar gas exposure of the tube alone, the deteriorated capability of the poly-crystalline tube was recovered only to -120 bar after a total of 1.2×104 cycles. The results form qualitative evidence of the crucial effects of impurity gas transport in metal bulks on trends in negative pressures of water in metal tubes. The thermodynamic and metallurgical causes of the time consumption for achieving high negative pressure in liquid/metal Berthelot tube systems are discussed.

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