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Abstract: PB2039

Type: Publication Only

Background
Hemorrhagic cystitis ( HC) is a diffuse inflammation of the bladder of an infectious or non-infectious etiology, causing bleeding of the bladder mucosa. Medications: (busulfan, endoxan, idarubicin, carboplatin), radiation, viruses, chemicals may be the cause of HC. HC occurs after approximately 35 days after stem cell/bone marrow transplantation and continues for approximately 23 days. Symptoms of cystitis may be caused by defect in the inflammatory response and increase the permeability of glycosaminoglycan layer, which covers the bladder mucosa, form a physiological barrier. There are no explicit guidelines defining appropriate treatment. Hyperbaric therapy (HBO) has been recognized clinically in the treatment of HC in the past 15 years. It is a non-invasive method involving the operation of 100% oxygen under increased pressure, which penetrates poorly perfused areas, patient exposure to 100% oxygen-saturated tissue oxygen efficiently.

Aims
We reviewed the records of 5 patients with HC who received hyperbaric oxygen as an adjunctive treatment.

Methods
We retrospectively analyzed the effectiveness of HOT in 5 patients in the years from 2012 to 2014. Among patients there were 3 men, aged from 31 to 41 years and 2 women aged from 40 to 43 years. Patients characteristics is shown in Table 1.

Patient No	Age yr	Sex	Diagnosis	Clinical status	Condidtioning regimen	Source for alloHSCT	GvHD prophylaxis
1	40	F	MDS	CR1	BuCyTym	PBSC, MUD	C, MTX, Gluc
2	41	M	AML	CR1	BuCyTym	PBSC, MUD	C, MTX, Gluc
3	39	M	ALL	CR1	TBI, CyTym	PBSC, MUD	C, MTX, Gluc
4	43	F	AML	CR1	BuCyTym	PBSC, MUD	C, MTX, Gluc
5	31	M	AML	CR1	BuCyTym	PBSC, MUD	C, MTX, Gluc

Abbreviations: C= cyclosporine, Tym= tymoglobuline, Gluc=glucocorticoids, MUD=matched unlrelated donor, MTX=methotrexate, 

Results
Clinical presentations of 5 patients with haemorrhagic  cystitis .

Patient No	Onset days post BMT	Hematuria (grade)	Ultrasound	GvHD (type)	GvHD (grade)	Viruria	Antiviral treatment before HBO
1	14	2	Bladder wall thickening	Cutaneous And Gastrointestinal	III	BKV	Cidofovir
2	24	2	Normal	Cutaneous	II	ADV	Cidofovir
3	15	2	Bladder wall thickening	Cutaneous	II	BKV+ADV	Cidofovir+Rybavirin
4	11	3	Bladder wall thickening	Cutaneous	II	BKV+ADV	Cidofovir+Rybavirin
5	55	2	Not performed	None		ADV	Cidofovir

The median time to onset of HC after allogeneic stem cell transplantation was 22 days (range, 11-55 days). In one patient, the symptoms did not appear until the day 55 after transplantation. Despite immunosuppressive therapy, all patients had macroscopic hematuria and GvHD. The BKV and ADV DNA were detected in urine and plasma samples in 2 patients, ADV DNA  was detected in urine and plasma in 2 other patients, and in the one patient, BKV was detected in both samples, respectively. The patients were treated with HOT (2.5 atmospheres for 60 minutes, 5 days per week) after treatment failure of bladder drainage flow, hyaluronic acid administered intravesically, as well as antiviral treatment. All patients showed complete resolution of hematuria and eradicaton of the virus after a median of 13 sessions (range, 11-30) of HOT. 

Summary
Hyperbaric oxygen therapy may be an alternative and promising therapy in the treatment of severe hemorrhagic cystitis.

Keyword(s): Allogeneic bone marrow transplant, Hemorrhagic cystitis, Unrelated donor

Session topic: Publication Only