Cyclophosphamide‐induced hemorrhagic cystitis in young patients with solid tumors: A single institution study

Saito, Yoshimasa; Kumamoto, Tadashi; Shiraiwa, Miki; Sonoda, Tomoko; Arakawa, Ayumu; Hashimoto, H.; Tamai, Ikumi; Ogawa, Chitose; Terakado, Hiroyuki

doi:10.1111/ajco.13048

Cited by 10 publications

(14 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, our cohort results were consistent with other studies published in the literature and do not support the use of mesna in prophylaxes against HC. 20,25,26 Although our finding might be in alignment with those of Tsuboi et al. 20 and Letendr et al., 28 who found that mesna could be harmful, one must consider other factors that may be involved.…”

Section: Discussionsupporting

confidence: 90%

“…12–14,21,22,24 Other studies either found no difference between mesna and the comparison group or found mesna to be harmful with increased risk of HC. 9,15,16,20,25–27 Studies compared mesna with other protective parameters, including hydration, bladder irrigation and forced diuresis. 10,15,25 Other studies simply compared mesna users with non-mesna users in terms of occurrence of HC.…”

Section: Resultsmentioning

confidence: 99%

“…16,20,27 On the other hand, two studies compared non-HC patients with HC patients in terms of risk factors. 9,26 Description of the main characteristics of each of the 14 included studies and their main findings is summarized in Table 6.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Incidence of hemorrhagic cystitis after cyclophosphamide therapy with or without mesna: A cohort study and comprehensive literature review

Almalag

Alasmari

Alrayes

et al. 2020

J Oncol Pharm Pract

View full text Add to dashboard Cite

Background Cyclophosphamide is an alkylating agent associated with significant toxicities, most importantly hemorrhagic cystitis. Many approaches including mesna use were established to reduce this toxicity. However, data on mesna efficacy are conflicting. Objective To investigate the incidence of hemorrhagic cystitis in patients receiving cyclophosphamide therapy with or without mesna. Methods A retrospective chart review was done on all adult patients receiving cyclophosphamide therapy with or without mesna at the King Saud University Medical City. The incidence of hemorrhagic cystitis was recorded. Patients receiving mesna were compared with those not receiving mesna. Data were reported as numbers and percentages, and appropriate statistical tests of association were used. This step was followed by a comprehensive literature review using appropriate keywords in PubMed from the inception of the database until August 2019. All studies of interest were reported. Results A total of 718 patients’ medical records were reviewed. The majority of the patients received mesna (n = 433, 60%). The mesna group had a greater incidence of hemorrhagic cystitis (3.5% vs. 0.4%, p < 0.004) and received a significantly larger cumulative dose (3103 ± 1696 vs. 2465 ± 1528, p < 0.001) mg of cyclophosphamide therapy. Our literature review revealed large differences in the conclusions of published trials with highly diverse study designs and populations, emphasizing on the need of large prospective trials to address this topic. Conclusion and relevance: Our study results do not support the use of mesna in preventing hemorrhagic cystitis. We found that the only influential factor in the development of hemorrhagic cystitis was the dose of cyclophosphamide therapy.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Incidence of hemorrhagic cystitis after cyclophosphamide therapy with or without mesna: A cohort study and comprehensive literature review

Almalag

Alasmari

Alrayes

et al. 2020

J Oncol Pharm Pract

View full text Add to dashboard Cite

show abstract

“…Hemorrhagic cystitis (HC) is a serious side effect accompanying the use of CYP, as evident in studies involving both animals and humans (Saito et al, 2018;Sherif et al, 2016). Hemorrhagic cystitis -HC is known as a diffused inflammation in the urinary bladder leading to bladder mucosa bleeding, and usually arises from using oxazaphosphorine chemotherapy like CYP and ifosfamide (Manikandan et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Uroprotective mechanisms of natural products against cyclophosphamide-induced urinary bladder toxicity: A comprehensive review

Sherif

2020

Acta Sci Pol Technol Aliment

View full text Add to dashboard Cite

One of the widely used anticancer drugs for the treatment of various neoplasms is cyclophosphamide (CYP). The inactive prodrug CYP is metabolized by cytochrome P450 enzyme into active metabolites, phosphoramide mustard and acrolein. The accumulation of acrolein metabolite inside the urothelium results in hemorrhagic cystitis (HC) which is a urotoxic adverse effect associated with the use of CYP. To counteract the occurrence of HC induced by CYP, Mesna is usually used, with allergic reactions reported in some cases. Therefore, several natural products have drawn much attention as alternative safe therapies to reduce the urotoxicity produced from the use of CYP. This review will focus on certain uroprotective mechanisms related to some medicinal plants that are used to ameliorate the CYP-induced urotoxicity in experimental models. The mechanisms involving oxidative stress, inflammation, immune system, apoptosis, DNA fragmentation, uroplakins, purinergic signaling and muscarinic receptors, and CytoP450 metabolism are discussed.

show abstract

“…Some authors have also opined that hyper-hydration is more safe and cost effective than mesna [20,21]. A single institutional study was done by Saito Y et al who showed that patients receiving low and intermediate doses of CP (< 1,500 mg/m 2 /day) would benefit from > 125 mL/h of fluids to prevent HC, and those getting high dose CP (> 1,500 mg/m 2 /day) should receive both mesna and vigorous hydration to prevent HC [22]. Majority of the evidence on the role of mesna in preventing CP-induced HC has been in rheumatological disorders, and even in the same, most of the data have been extrapolated from ifosfamide in cancer patients and from animal models.…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic Cystitis With Low-Dose Cyclophosphamide Therapy for Breast Cancer: A Rare Occurrence

2019

View full text Add to dashboard Cite

Cyclophosphamide (CP) is known to cause hemorrhagic cystitis (HC), and this adverse effect is more commonly seen in patients receiving high individual doses used in the treatment of sarcomas and conditioning regimens during hematopoietic cell transplant. There are a few reported cases of HC in doses used for breast cancer. We report the case of a 63-year-old lady with stage IIA breast cancer who was started on adjuvant CP and docetaxel therapy at a dose of 600 mg/m 2 and 75 mg/m 2 respectively. She developed gross hematuria in less than 24 h after her first cycle and was found to have evidence suggestive of HC on cystoscopy done subsequently. She went on to complete three more cycles of adjuvant chemotherapy with CP and docetaxel with concurrent mesna and hydration. She did not develop any further episodes of hematuria. We review the literature pertaining to our case, and also compare the characteristics of the patient in our case with previously described cases of breast cancer who developed HC with low-dose CP.

show abstract

Cyclophosphamide‐induced hemorrhagic cystitis in young patients with solid tumors: A single institution study

Abstract: Our supportive care measures may be effective in preventing CPA-induced HC. Patients who receive CPA doses < 1500 mg/m /day should get ≥125 mL/m /h of infused fluid, regardless of mesna usage; those who receive of CPA ≥1500 mg/m /day should also receive mesna and vigorous hydration.

Cited by 10 publications

References 18 publications

Incidence of hemorrhagic cystitis after cyclophosphamide therapy with or without mesna: A cohort study and comprehensive literature review

Incidence of hemorrhagic cystitis after cyclophosphamide therapy with or without mesna: A cohort study and comprehensive literature review

Uroprotective mechanisms of natural products against cyclophosphamide-induced urinary bladder toxicity: A comprehensive review

Hemorrhagic Cystitis With Low-Dose Cyclophosphamide Therapy for Breast Cancer: A Rare Occurrence

Contact Info

Product

Resources

About