Treatment of late-onset hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation: the role of corticosteroids.

Abstract

We aimed to evaluate the treatments, particularly the role of corticosteroids, in patients with late-onset hemorrhagic cystitis (LOHC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). One hundred and sixty-three consecutive patients who underwent non-T-cell-depleted allo-HSCT and met the criterion of LOHC after allo-HSCT were enrolled in this study. The median time from allo-HSCT to the occurrence of LOHC was 29 (range, 4-155) days. Pathogens identified in blood and/or urine samples from 143 patients were mostly viruses. All of the patients with LOHC received intravenous fluid hydration, alkalization, and forced diuresis, of which 2 patients achieved complete remission (CR) after these treatments. The remaining 161 patients received anti-infection therapies and 71 achieved CR after the therapies. Corticosteroids were additionally applied to 83 out of 90 patients who did not achieve CR after anti-infection therapies, and 88.0% (n = 73) of them showed a grade 3 to 4 LOHC at the beginning of corticosteroid therapy. Thirty-five patients showed an immediate response (CR or downgraded at least one grade) within 1 week after the beginning of the corticosteroid therapy. Sixty-four patients (77.1%) achieved CR after corticosteroid therapy, and the median period from the beginning of corticosteroid therapy to CR was 17 days. Thus, we observed that viruses were the most common pathogens in LOHC after allo-HSCT and that anti-infection therapies were critical. For patients not showing a satisfactory response to anti-infection therapies, additional corticosteroid therapy may help to achieve CR.

• Authors: Xiao-Dong Mo, Xiao-Hui Zhang, Lan-Ping Xu, Yu Wang, Chen-Hua Yan, Huan Chen, Yu-Hong Chen, Wei Han, Feng-Rong Wang, Jing-Zhi Wang, Kai-Yan Liu, Xiao-Jun Huang
• Journal: Annals of hematology (Ann Hematol) Vol. 97 Issue 7 Pg. 1209-1217 (Jul 2018) ISSN: 1432-0584 [Electronic] Germany
• PMID: 29532160 (Publication Type: Journal Article)

Chemical References

• Adrenal Cortex Hormones
• Antiviral Agents
• Diuretics

Topics

• Acute Disease
• Adolescent
• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Allografts
• Antiviral Agents (therapeutic use)
• Child
• Combined Modality Therapy
• Cystitis (drug therapy, etiology)
• Diuretics (therapeutic use)
• Drug Evaluation
• Drug Therapy, Combination
• Female
• Fluid Therapy
• Hematologic Diseases (therapy)
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Hematuria (drug therapy, etiology)
• Humans
• Male
• Middle Aged
• Remission Induction
• Retrospective Studies
• Transplantation Conditioning (adverse effects)
• Virus Diseases (complications, drug therapy)
• Young Adult