Granulocyte-macrophage colony stimulating factor bladder irrigation prevents hemorrhagic cystitis after hematopoietic stem cell transplantation / 中国组织工程研究

ABSTRACT

BACKGROUND: Hemorrhagic cystitis remains a common complication of hematopoietlc stem cell transplantation.Granulocyte-macrophage colony stimulating factor (GM-CSF) affects proliferation and differentiation of hematopoietic stem/progenitor cells, adjusts functions of monocytes, granulocytes, lymphocytes and endothelial cells.OBJECTIVE: To investigate the protective effects of GM-CSF bladder irrigation in hemorrhagic cystitis after allogeneic hematopoietic stem call transplantation.DESIGN: Case analysis.PARTICIPANTS: A total of 15 hematopathy patients undergoing allogenic hematopoietic stem cell transplantation at the Zhongshan Hospital of Sun Yat-sen University from January 2004 to August 2006 (routine treatment group). A total of 16 hematopathy patients undergoing allogenic hematopoietic stem cell transplantation from September 2006 to December 2008 (GM-CSF group).METHODS: In the routine treatment group, patients received mesna, hydration, alkalization and forced diuresis in the prevention of hemorrhagic cystitis. In the GM-CSF group, GM-CSF was infused into the bladder in addition to mesna,hydration, alkalization and forced diuresis in the prevention of hemorrhagic cystitis 24 hours before cyclophosphamide treatment. Catheter was extracted 3 days following cyclophosphamide withdraw. Following washing with saline, the bladder was emptied. 10 mL of saline and 5 mL of lidocaine were added into 300 μg of GM-CSF. The mixture was infused into the bladder for 60-120 minutes.MAIN OUTCOME MEASURES: The following parameters were measured occurrence of hemorrhagic cystitis and its correlation to graft versus host disease, as well as the occurrence of cytomegalovirus infection and urinary system infection.RESULTS: Compared with routine treatment group, the occurrence rate of hemorrhagic cystitis was significantly decreased in the GM-CSF group (x2=4.39, P < 0.05), mean duration of hemorrhagic cystitis and duration of hospitalization were significantly shortened (t=3.97, P < 0.05; t=3.13, P < 0.05), and the occurrence rate of over grade HI hemorrhagic cystitis was significantly reduced (x2=5.04, P < 0.05). Cystitis degree was associated with degree and duration of graft-versus-host disease (r = 0.76).Compared with the routine treatment group, cytomegalovirus infection rate was slightly decreased in the GM-CSF group (x2=0.28, P> 0.05), and occurrence rate of over grade Ⅲ hemorrhagic cystitis was higher in patients with cytomegalovirus infection.Compared with the routine treatment group, the occurrence rate of urinary system infection was slightly reduced in the GM-CSF group (x2=0.28, P > 0.05).CONCLUSION: GM-CSF bladder irrigation is well tolerated and often effective, and should be considered as a preparative regimen of hemorrhagic cystitis after allogeneic hematopoietic stem call transplantation.