Successful treatment of severe hemorrhagic cystitis with cystectomy following matched donor allogeneic hematopoietic cell transplantation

Abstract

Summary:We report a case of severe hemorrhagic cystitis complicating high-dose cyclophosphamide (CY), total body irradiation and allogeneic hematopoietic stem cell transplantation (HSCT). Supportive care with i.v. hydration, platelet transfusions, continuous bladder irrigation and aluminum irrigation of the bladder was ineffective and the patient developed multiple complications from hemorrhagic cystitis. His condition became critical with persistent bleeding, pulmonary edema and acute renal failure. These problems resolved following successful simple cystectomy and ileal conduit. The patient did not develop any acute or chronic complications following surgery. He is alive with a good quality of life and in third remission after receiving salvage chemotherapy 14 months after his transplantation. Bone Marrow Transplantation (2000) 26, 899-901.

Pediatric hemorrhagic cystitis

“…In a randomized trial, Bedi et al [21] prospectively evaluated 95 [21]. A more recent small prospective study by Cesaro et al further reinforced this concept by finding that of the 74 pediatric BMT patients analyzed those who had two consecutive BK virus-positive urine samples had a sensitivity of 100% and specificity of 82% for developing HC [22].…”

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

“…Surgical treatment is the final procedure to control life-threatening HC, which includes flexible cystoscopy, evacuation of blood clots, cauterization and cystectomy, 28 but is associated with high morbidity and mortality.…”

“…[14][15][16][17] The use of formalin, alum, prostaglandin E1, estrogens, FVIIa, factor XIII, hyperbaric oxygen treatment, intravesicular sodium hyaluronate, recombinant human epidermal growth factor or recombinant human GM-CSF has been described, but their efficacy remains controversial. [18][19][20][21][22][23][24][25][26][27] Severe HC may also require surgical treatment with cystoscopy and cauterization, and even cystectomy when previous methods have failed, 28 but it is limited by the disadvantage of operation.…”

Hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation: donor type matters

“…Although mild forms usually resolve with supportive treatment, severe HC may require antiviral therapy such as vidarabine, hyperbaric oxygen treatment, amifostine, factor XIII, bladder irrigation with intravesicular instillation of E-aminocaproic acid, methyl prednisolone or formalin, cystoscopy and cauterization, and even cystectomy. [4][5][6][7][8][9][10][11][12] In general, alkylating agents such as cyclophosphamide (CTX), radiation therapy, or adenovirus and BK polyoma virus infection have been implicated in the etiology of HC. [13][14][15][16][17][18][19][20][21][22][23][24] However, previous studies evaluating risk factors for HC have been carried out on either small numbers of patients or in heterogeneous populations including different preparative regimens.…”