Use of high-dose mesna and hyperhydration leads to lower incidence of hemorrhagic cystitis after posttransplant cyclophosphamide-based allogeneic transplantation.

Abstract

Currently, there is no consensus on best practices to prevent hemorrhagic cystitis (HC) in patients receiving posttransplant cyclophosphamide (PTCy). We retrospectively reviewed 194 patients undergoing their first hematopoietic cell transplant (HCT) who received PTCy from 2014 to 2018 to describe the incidence and severity of HC, identify potential risk factors, and impact of HC on HCT outcomes. Standard HC prophylaxis was hyperhydration with forced diuresis and mesna at 320% the daily dose of PTCy. Incidence of HC was 31.4% at day +100 of HCT. Median onset of HC was 12 days with 11.5% grade 3 HC and no Grade 4 HC. Patients with chemical HC experienced earlier onset (7 days vs. 34 days, p < 0.001) with a shorter median resolution time (5 days vs. 14 days, p = 0.001) when compared to BK-associated HC. In multivariate analysis, age above 60 years (HR 4.16, p = 0.006) and myeloablative conditioning (HR 2.44, p = 0.054) were associated with higher risk for HC, but overall, HC did not affect nonrelapse mortality or overall survival. In conclusion, hyperhydration with forced diuresis combined with aggressive mesna dosing is an effective strategy in preventing severe PTCy-associated HC, subsequently preventing any negative impact on transplant outcome.

• Authors: Stephanie Mac, Dat Ngo, Dongyun Yang, Jason Chen, Haris Ali, Shukaib Arslan, Sanjeet Dadwal, Amandeep Salhotra, Thai Cao, Nicole Karras, Ibrahim Aldoss, Paul Koller, Andrew Artz, Ahmed Aribi, Karamjeet Sandhu, Vinod Pullarkat, Anthony Stein, Guido Marcucci, Stephen J Forman, Ryotaro Nakamura, Monzr M Al Malki
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 56 Issue 10 Pg. 2464-2470 (10 2021) ISSN: 1476-5365 [Electronic] England
• PMID: 34108676 (Publication Type: Journal Article)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer Nature Limited.

Chemical References

• Cyclophosphamide
• Mesna

Topics

• Cyclophosphamide (adverse effects)
• Cystitis (epidemiology, etiology)
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Incidence
• Mesna (adverse effects)
• Middle Aged
• Retrospective Studies
• Transplantation, Homologous