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

Abstract

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.

The correlation between the level of 3-hydroxypropyl mercapturic acid, CYP2B6 polymorphisms, and hematuria occurrences after cyclophosphamide administration and its bioanalytical methods: A systematic review

“…10 There is a variety of literature that has explained the incidences of hematuria after cyclophosphamide administration, such as analysis of 3-HPMA levels in breast cancer patients after giving cyclophosphamide using ultra-high-performance liquid chromatography-tandem mass spectrometry and analysis of the incidence of hemorrhagic cystitis after administration of low-dose cyclophosphamide. [11][12] However, there is still no research stating the correlation between the hematuria incidences, 3-HPMA levels, and CYP2B6 polymorphism in a single comprehensive manuscript. In this study, we tried to find and write down the connections between these three things.…”

“…There is a reported case of hemorrhagic cystitis in 24 hours after the first cycle of therapy regimen of cyclophosphamide and docetaxel at a dose of 600 mg/m 2 and 75 mg/m 2 on a 63 years old woman with stage IIA breast cancer. 12 The toxicity of acrolein against the bladder can be prevented. MESNA drugs, or 2mercaptoethanesulfonate, and strong hydration to increase urination are considered effective in preventing CPA-induced hemorrhagic cystitis.…”