Late-onset hemorrhagic cystitis after hematopoietic stem cell transplantation in children

Abstract

Summary:We analyzed the incidence, complications, and risk factors for late-onset hemorrhagic cystitis (HC) in 256 children undergoing hematopoietic stem cell transplantation (HSCT). Twenty-six recipients (10.2%) developed late-onset HC between 3 and 270 days (median, 33 days) after HSCT. In most patients, the severity of HC was mild to moderate, and spontaneous resolution occurred. Three children developed bladder tamponade, and one required suprapubic cystotomy. Four children died in the early post-transplant period without resolution of HC, but HC was not the direct cause of death in any patient. Twenty-two patients recovered within 6-86 days (median, 16 days) of onset. Three predisposing factors were identified for development of late-onset HC by multivariate analysis: allogeneic HSCT, older age (у7 years), and busulphan for pretransplant conditioning were significantly associated with late-onset HC (P ‫؍‬ 0.022, P ‫؍‬ 0.044 and P ‫؍‬ 0.036, respectively). Excretion of adenovirus type 11 was demonstrated in six of 22 patients at the onset of cystitis. We suspect that reactivation of virus may be a major pathogenic factor in lateonset HC, but several clinical factors are also associated.

Male predominance among Japanese adult patients with late-onset hemorrhagic cystitis after hematopoietic stem cell transplantation

“…Similarly, the incidence of childhood HC is two to three times higher in boys than in girls. 8 Furthermore, AdV type 11 was shown to be the major causative agent in childhood HC, and its incidence is higher in Japan than in the West. 9 Considering all of these findings together, we considered the hypothesis that AdV type 11 may show tropism to a male-specific organ around the urinary tract, and acute infection in childhood may be followed by a latent infection in this organ.…”

Selective embolization of the internal iliac arteries for the treatment of severe hemorrhagic cystitis following hematopoietic SCT

“…The incidence of HC in childhood series is lower than that of adult series, because of the lower incidence of latent infection with viruses in younger patients. 3 Viruses are associated with HC. The role of a human polyomavirus is clearly established in adult BMT patients, whereas infection by adenovirus is frequently detected in children.…”

“…Hemorrhagic cystitis (HC) is recognized as a significant cause of morbidity and sometimes mortality in patients undergoing hematopoietic SCT (HSCT) [1][2][3] shows a clinical manifestation varying from microscopic hematuria to severe hemorrhage with obstructive renal failure. 4,5 Its reported incidence ranges from less than 10% to more than 70% due to the discrepancies in definition criteria and the types of transplant.…”

Incidence and treatment of hemorrhagic cystitis in children given hematopoietic stem cell transplantation: a survey from the Italian association of pediatric hematology oncology–bone marrow transplantation group

“…2,4 The pathogenesis of HC has not been completely clarified. 5 Early-onset HC has been associated mainly with cyclophosphamide and busulfan administration. These drugs can damage the uroepithelium directly or through their metabolites.…”