Hemorrhagic cystitis in children treated with alkylating agent cyclophosphamide: The experience of a medical center in Taiwan.

Abstract

BACKGROUND/PURPOSE:

Hemorrhagic cystitis is a common complication with chemotherapeutic alkylating agents. We investigated the possible prognostic factors of cyclophosphamide-induced hemorrhagic cystitis in children.

METHODS:

Medical records of children (< 18 years old) with cyclophosphamide-related hemorrhagic cystitis were collected retrospectively from January 2000 to December 2010 in a tertiary care center. We also prospectively enrolled children (< 18 years old) with cyclophosphamide treatment.

RESULTS:

The retrospective study consisted of 23 patients whose median age was 11 years. The median day of onset time was 1 day after cyclophosphamide usage. The hemato-oncological diseases included acute leukemia (39.1%), lymphoma (13%), blastoma (13%), sarcoma (13%), aplastic anemia (13%), and others (8.7%). Patients who received bone marrow transplantation (BMT) had significantly longer duration of hemorrhagic cystitis than those who did not receive BMT (p < 0.05). Serum uric acid, checked prior to and after the onset of hemorrhage cystitis, was significantly lower after the development of hemorrhagic cystitis (p < 0.05). In the prospective study, 11 children were enrolled with a median age of 5 years. The urinary nitrite/nitrate and 8-iso-prostaglandin F2α levels increased significantly after cyclophosphamide usage (p < 0.05).

CONCLUSION:

Alteration serum uric acid level and BMT could be indicators for severe hemorrhagic cystitis. The elevated levels of urinary nitrite/nitrate and 8-iso-prostaglandin F2α may indicate the essential roles played by nitric oxide syntheses and reactive oxidative stress in cyclophosphamide-induced hemorrhagic cystitis. These findings may help clinicians formulate a better strategy for treating cyclophosphamide-induced hemorrhagic cystitis.

• Authors: Ching-Chia Wang, Te-I Weng, Meng-Yao Lu, Rong-Sen Yang, Kai-Hsin Lin, Mei-Hwan Wu, Shing-Hwa Liu
• Journal: Journal of the Formosan Medical Association = Taiwan yi zhi (J Formos Med Assoc) Vol. 114 Issue 8 Pg. 691-7 (Aug 2015) ISSN: 0929-6646 [Print] Singapore
• PMID: 23880225 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013. Published by Elsevier B.V.

Chemical References

• Antineoplastic Agents, Alkylating
• Uric Acid
• Cyclophosphamide

Topics

• Adolescent
• Antineoplastic Agents, Alkylating (adverse effects)
• Bone Marrow Transplantation (adverse effects)
• Child
• Child, Preschool
• Cyclophosphamide (adverse effects)
• Cystitis (chemically induced)
• Female
• Hemorrhage (chemically induced)
• Humans
• Male
• Pilot Projects
• Prospective Studies
• Retrospective Studies
• Taiwan
• Tertiary Care Centers
• Uric Acid (blood)
• Urinary Bladder (drug effects)