A Clinical Review of the Different Strategies to Minimize Hemorrhagic Cystitis Associated with the Use of Post-Transplantation Cyclophosphamide in an Allogeneic Transplant

Ngo, Dat; Samuels, Diana; Chen, Jason; Koller, Paul; Malki, Monzr M. Al

doi:10.1016/j.jtct.2022.05.012

Cited by 10 publications

(5 citation statements)

References 57 publications

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“…A major concern with high‐dose PTCY is the incidence of fatal cardiac toxicity and haemorrhagic cystitis 17–21 . Regarding the former, we did not have detailed information on causes of cardiac death in this study.…”

Section: Discussionmentioning

confidence: 98%

“…A major concern with high-dose PTCY is the incidence of fatal cardiac toxicity and haemorrhagic cystitis. [17][18][19][20][21] Regarding the former, we did not have detailed information on causes of cardiac death in this study. Therefore, we focused on early death due to cardiac complications and showed that this occurred in zero cases in the reduced-dose group and seven cases in the standard-dose group.…”

Section: Discussionmentioning

confidence: 99%

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Low‐ versus standard‐dose post‐transplant cyclophosphamide as GVHD prophylaxis for haploidentical transplantation

Fuji,

Sugita,

Najima

et al. 2023

Br J Haematol

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SummaryHaploidentical haematopoietic cell transplantation (haplo‐HCT) using post‐transplant cyclophosphamide (PTCY) as graft‐versus‐host disease (GVHD) prophylaxis is the standard of care for various haematological malignancies. The original PTCY dose after haplo‐HCT was 100 mg/kg, but no dose‐finding studies have been performed to identify the optimal dose. We performed a retrospective analysis to compare standard‐dose PTCY (100 mg/kg) with reduced‐dose PTCY (80 mg/kg): 969 in the standard‐dose group and 538 in the reduced‐dose group. As there was a significant difference between the two groups regarding patient and transplant characteristics, we performed propensity score (PS) matching. After PS matching, 425 patients in each group were included. The probabilities of 2‐year OS were 55.9% in the standard‐dose group and 47.0% in the reduced‐dose group (p = 0.36). The cumulative incidences of 2‐year non‐relapse mortality were 21.3% in the standard‐dose group and 20.5% in the reduced‐dose group (p = 0.55). There was no significant difference in the incidence of acute (grade II–IV 29.2% [95% CI, 24.9–33.6] vs. 25.3% [95% CI, 21.3–29.6]; grade III–IV 7.3% [95% CI, 5.1–10.0] vs. 6.6% [95% CI, 4.5–9.3]) or chronic GVHD. In conclusion, reduced‐ and standard‐dose PTCY were comparable in terms of major clinical outcomes.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Low‐ versus standard‐dose post‐transplant cyclophosphamide as GVHD prophylaxis for haploidentical transplantation

Fuji,

Sugita,

Najima

et al. 2023

Br J Haematol

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“…They found similar incidence and severity of HC when they compared haploidentical HCT with MMUD HCT. 33 , 36 This situation may make BK virus reactivation and HC, which is one of the important obstacles to PTCy preference, an acceptable risk factor.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Infectious Complications in Patients Receiving High-Dose Cyclophosphamide as GvHD After Transplantation From A 9/10 HLA-Matched Unrelated Donor with Standard GvHD Prophylaxis After Transplant From A Full Matching Donor

SAYIN

2024

Mediterr J Hematol Infect Dis

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Background: The aim of this study was to evaluate whether cyclophosphamide administered after allogeneic stem cell transplantation (ASCT) from 9/10 HLA-Matched Unrelated Donors (MMUD) increases the rates of bloodstream infections (BSI) (fungal, viral (CMV, BK, hepatitis), bacterial), infectious complications (hemorrhagic cystitis(HC)) and infection-related mortality compared to allogeneic stem cell transplantation from matched related donors (MRD). Metods: This is a retrospective multicenter study. 45 MMUD ASCT patients who received posttransplant cyclophosphamide + methotrexate + calcineurin inhibitor compared with 45 MRD ASCT patients who received methotrexate + calcineurin inhibitor. Results: Although there was a statistically significant prolongation of neutrophil engraftment time in the PTCy arm, there was no statistically significant difference in bacterial BSI frequencies between the groups (PTCy; 9(20%), control;8 (17.8%), p=0.778). The distribution of CMV infection in the first 100 days was similar (p=0.827) but the distribution of CMV infection rate between the 100th and 365th days, was observed more frequently in the control group (p=0.005). HC rates and their grades were similar in both groups (PTCy; 4 (8.8%), control;6 (13.3%) p=0.502). The rates of VZV infection and invasive aspergillosis were similar in the PTCy and control groups (13.3% in the PTCy, and 17.8% in the control group p=0.561). IRM rate was statistically similar in both groups (13.3% in the PTCy arm and 17.8% in the control arm) Conclusions: The addition of PTCy to standard GvHD prophylaxis in MMUD ASCT does not lead to an increase in CMV reactivation, bacterial BSI, invasive fungal infection, viral hemorrhagic cystitis or infection-related mortality.

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“…Diuretics use is a possible strategy to reduce volume overload; however, it may lead to acute kidney injury when used excessively. Therefore, in patients with comorbidities in which complications related to volume overload are expected, such as congestive heart failure, ascites, and chronic renal failure, the use of mesna may be indicated as an alternative to hyperhydration [37,42,50]. Although the administration of large volumes of fluid is considered a standard of care for uroprotection in patients under cyclophosphamide therapy, it has never been properly assessed in patients with systemic autoimmune rheumatic diseases.…”

Section: Is Mesna Indicated For Subgroups Of Patients Under Cyclophos...mentioning

confidence: 99%

Position statement of the Brazilian society of Rheumatology on mesna use as a preventive therapy for bladder disease in patients with systemic autoimmune diseases and systemic vasculitis under cyclophosphamide treatment

Souza,

Dantas,

Montandon

et al. 2024

Adv Rheumatol

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Objective To review current literature to support the use of mesna as a preventive therapy for hemorrhagic cystitis and bladder cancer in patients with systemic autoimmune diseases and systemic vasculitis treated with cyclophosphamide. Materials and methods The search for articles was conducted systematically through MEDLINE, LILACS, Cochrane Library, and Embase databases. Only articles in English were selected. For available records, titles and abstracts were selected independently by two investigators. Results Eighteen studies were selected for analysis. The known adverse effects of cyclophosphamide were hematological toxicity, infections, gonadal toxicity, teratogenicity, increased risk for malignancy and hemorrhagic cystitis. Long-term toxicity was highly dependent on cyclophosphamide cumulative dose. The risk of bladder cancer is especially higher in long-term exposure and with cumulative doses above 36 g. The risk remains high for years after drug discontinuation. Hemorrhagic cystitis is highly correlated with cumulative dose and its incidence ranges between 12 and 41%, but it seems to be lower with new regimens with reduced cyclophosphamide dose. No randomized controlled trials were found to analyze the use of mesna in systemic autoimmune rheumatic diseases and systemic vasculitis. Retrospective studies yielded conflicting results. Uncontrolled prospective studies with positive results were considered at high risk of bias. No evidence was found to support the use of mesna during the treatment with cyclophosphamide for autoimmune diseases or systemic vasculitis to prevent hemorrhagic cystitis and bladder cancer. In the scenarios of high cumulative cyclophosphamide dose (i.e., > 30 g), patients with restricted fluid intake, neurogenic bladder, therapy with oral anticoagulants, and chronic kidney disease, mesna could be considered. Conclusion The current evidence was found to be insufficient to support the routine use of mesna for the prophylaxis of hemorrhagic cystitis and bladder cancer in patients being treated for systemic autoimmune diseases and systemic vasculitis with cyclophosphamide. The use may be considered for selected cases.

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A Clinical Review of the Different Strategies to Minimize Hemorrhagic Cystitis Associated with the Use of Post-Transplantation Cyclophosphamide in an Allogeneic Transplant

Cited by 10 publications

References 57 publications

Low‐ versus standard‐dose post‐transplant cyclophosphamide as GVHD prophylaxis for haploidentical transplantation

Low‐ versus standard‐dose post‐transplant cyclophosphamide as GVHD prophylaxis for haploidentical transplantation

Comparison of Infectious Complications in Patients Receiving High-Dose Cyclophosphamide as GvHD After Transplantation From A 9/10 HLA-Matched Unrelated Donor with Standard GvHD Prophylaxis After Transplant From A Full Matching Donor

Position statement of the Brazilian society of Rheumatology on mesna use as a preventive therapy for bladder disease in patients with systemic autoimmune diseases and systemic vasculitis under cyclophosphamide treatment

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