Risk Factors of Hemorrhagic Cystitis after Allogeneic Stem Cell Transplantation / 대한혈액학회지

ABSTRACT

BACKGROUND: Hemorrhagic cystitis (HC) is one of major causes of morbidity during hematopoietic stem cell transplantation (HSCT), occurring in 7~52% of transplant recipients. We have analyzed the incidence, risk factors, and complications of early ( or = grade II) with urinary obstruction and renal failure (n=2). One patient with grade IV HC died of pneumonia associated with persistent HC. Early and late- onset HC developed at median 9 (2~20) and 55 (31~100) days post-transplant, respectively. Median duration of HC was 16 (3~153) days. Of 23 evaluable patients for study in urine, BK virus was detected in 52% by culture and in 61% by PCR, whereas adenovirus in 18% by PCR. By univariate analysis, disease of aplastic anemia (P=0.03) and non-use of radiation in conditioning regimen (P=0.003) were risk factors for early-onset HC, while the use of busulfan in conditioning regimen (P= 0.02) and grade II-IV acute graft-versus-host disease (GVHD) (P=0.00001) for late-onset HC. By multivariate analysis, use of busulfan (RR=16.62, P=0.002) and aplastic anemia than other disease (RR=9.6, P=0.008) were unfavorable factor for early-onset HC, as only grade II-IV acute GVHD (RR=6, P=0.001) for late- onset HC. CONCLUSION: More than half of patients with HC developed after allogeneic HSCT were associated with urinary excretion of BK virus. Because of HC is one of the important causes of morbidity after allogeneic HSCT, special attention should be paid to attempting the prevention of HC in patients with high-risk for the development of HC.