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INCIDENCE AND RISK FACTORS FOR THE DEVELOPMENT OF HEMORRHAGIC CYSTITIS ON HAPLOIDENTICAL TRANSPLANTATION
Author(s):
Maria Saez-Perdomo
,
Maria Saez-Perdomo
Affiliations:
Hematology,Hospital Universitario de Gran Canaria Dr. Negrín,Las Palmas de Gran Canaria,Spain
Maria Perera
,
Maria Perera
Affiliations:
Hematology,Hospital Universitario de Gran Canaria Dr. Negrín,Las Palmas de Gran Canaria,Spain
Juan Viedma
,
Juan Viedma
Affiliations:
Hematology,Hospital Universitario de Gran Canaria Dr. Negrín,Las Palmas de Gran Canaria,Spain
Carlos Rodriguez
,
Carlos Rodriguez
Affiliations:
Hematology,Hospital Universitario de Gran Canaria Dr. Negrín,Las Palmas de Gran Canaria,Spain
Alexia Suarez
,
Alexia Suarez
Affiliations:
Hematology,Hospital Universitario de Gran Canaria Dr. Negrín,Las Palmas de Gran Canaria,Spain
Luisa Guerra
,
Luisa Guerra
Affiliations:
Hematology,Hospital Universitario de Gran Canaria Dr. Negrín,Las Palmas de Gran Canaria,Spain
Jezabel Lopez
,
Jezabel Lopez
Affiliations:
Hematology,Hospital Universitario de Gran Canaria Dr. Negrín,Las Palmas de Gran Canaria,Spain
Teresa Molero
,
Teresa Molero
Affiliations:
Hematology,Hospital Universitario de Gran Canaria Dr. Negrín,Las Palmas de Gran Canaria,Spain
Santiago Jimenez
Santiago Jimenez
Affiliations:
Hematology,Hospital Universitario de Gran Canaria Dr. Negrín,Las Palmas de Gran Canaria,Spain
(Abstract release date: 05/18/17) EHA Library. Perera Alvarez M. 05/18/17; 182887; PB2174
Maria del MAr Perera Alvarez
Maria del MAr Perera Alvarez
Contributions
PDF Abstract
Abstract

Abstract: PB2174

Type: Publication Only

Background
Hemorrhagic cystitis (HC) is a serious complication ocurring after allogenic hematopoietic stem cell transplantation (HSCT) more frequent on haploidentical (haplo) HSCT, with an incidence of 10% to 70%(Silva et al Haematologica 2010;95(7):1183–1190) associated mainly with the effect of cytotoxic agents such as Cyclophosphamyde (Cy). The conditioning regimen, BKPyV infection and graft versus host disease have an implication in the incidence. Other authors related the reactivation of CMV and a previous transplantation as risk factors to HC development(Ruggeri et al Transplant Infectious Disease 2015:17:822–830).

Aims
With this study we aim to describe the HC incidence and risk factors in all haplo-HSCT performed in the Canary Islands.

Methods
We analyzed all consecutive haplo-HSCT from family donors performed at our Hospital between 2013 and 2016. The conditioning regimen used for the transplant was the Hopkins haplo protocol with high dose Cy (50 mg/kg on days 3 and 4) posttransplantation (PTCy). We used as HC prophylaxis intense hydratation on the Cy administration day and the following 24 hours (using bladder wash only in 1 patient with cardiac dysfunction) and perfused MESNA at 100% of Cy dose beginig 15 minutes before the Cy administration on 16 pts and at 20% of the last dose at 0, 4 and 8 hours on all pts. We used SPSS V.23 to determine the cumulative incidence (CI) of HC.

Results

We performed 20 haplo-HSCT, of which 10 were males (1 was transplanted 3 times) and 8 were women. The mean age was 40 (range 16-64). The pts presented the following diagnosis: AML (10), ALL (1), EH (5), NHL (3), AM (1). 45% of pts received the haplo-HSCT in remission, 50% with refractory disease and 5% of pts did not receive previous treatment.
6 pts developed HC (36.5% CI at day +80) (fig 1a) with a median time from haplo-HSCT to onset of 23 days (range 3-42), 1 (17%) was grade I, 4 (66%) grade II and 1 (17%) grade IV. The grade I case did not received the MESNA infusion like most of the other pts. No pts died due to HC and all cases resolved without sequelae.
12 pts received Cy pre- and post-transplant and only 8 pts received PTCy. The CI at day +80 for the pts with PTCy was 33.3% and for Cy pre- and post-transplant 38.3% (fig1b). We found no statistically significant difference on the CI of HC between these two groups.
The development of HC was related to Cy in 1 patient, who suffered from this complication on the second and third haplo-HSCT. For the rest of the pts (after day +30) the HC was related to BKPyV infection, as a consequence of the immunosuppression state of the patient, we also observed all these pts had positive serum viral load for CMV.

Conclusion

The incidence of HC associated to post-HSCT high Cy dose in our series is 15% lower than other ones. Most of them on grade 1 or 2 and without mortality associated.
The risk of HC is high, particularly in the setting of highly pre-treated patients (especially those undergoing a 2nd transplant). The development of HC after day +30 is evidently associated to BKPyV as a contributing factor for continuous inflammation and CMV reactivation (as an immunosuppression marker).
In our study, HC did not have an impact on mortality of high-risk patients after haplo-HSCT. The HC remains frequent with a high morbidity in particular when it is severe, often causing prolonged hospitalization and resource use. We need further studies to recognize the at-risk population early.

Session topic: 22. Stem cell transplantation - Clinical

Keyword(s): Hemorrhagic cystitis, Haploidentical stem cell transplantation

Abstract: PB2174

Type: Publication Only

Background
Hemorrhagic cystitis (HC) is a serious complication ocurring after allogenic hematopoietic stem cell transplantation (HSCT) more frequent on haploidentical (haplo) HSCT, with an incidence of 10% to 70%(Silva et al Haematologica 2010;95(7):1183–1190) associated mainly with the effect of cytotoxic agents such as Cyclophosphamyde (Cy). The conditioning regimen, BKPyV infection and graft versus host disease have an implication in the incidence. Other authors related the reactivation of CMV and a previous transplantation as risk factors to HC development(Ruggeri et al Transplant Infectious Disease 2015:17:822–830).

Aims
With this study we aim to describe the HC incidence and risk factors in all haplo-HSCT performed in the Canary Islands.

Methods
We analyzed all consecutive haplo-HSCT from family donors performed at our Hospital between 2013 and 2016. The conditioning regimen used for the transplant was the Hopkins haplo protocol with high dose Cy (50 mg/kg on days 3 and 4) posttransplantation (PTCy). We used as HC prophylaxis intense hydratation on the Cy administration day and the following 24 hours (using bladder wash only in 1 patient with cardiac dysfunction) and perfused MESNA at 100% of Cy dose beginig 15 minutes before the Cy administration on 16 pts and at 20% of the last dose at 0, 4 and 8 hours on all pts. We used SPSS V.23 to determine the cumulative incidence (CI) of HC.

Results

We performed 20 haplo-HSCT, of which 10 were males (1 was transplanted 3 times) and 8 were women. The mean age was 40 (range 16-64). The pts presented the following diagnosis: AML (10), ALL (1), EH (5), NHL (3), AM (1). 45% of pts received the haplo-HSCT in remission, 50% with refractory disease and 5% of pts did not receive previous treatment.
6 pts developed HC (36.5% CI at day +80) (fig 1a) with a median time from haplo-HSCT to onset of 23 days (range 3-42), 1 (17%) was grade I, 4 (66%) grade II and 1 (17%) grade IV. The grade I case did not received the MESNA infusion like most of the other pts. No pts died due to HC and all cases resolved without sequelae.
12 pts received Cy pre- and post-transplant and only 8 pts received PTCy. The CI at day +80 for the pts with PTCy was 33.3% and for Cy pre- and post-transplant 38.3% (fig1b). We found no statistically significant difference on the CI of HC between these two groups.
The development of HC was related to Cy in 1 patient, who suffered from this complication on the second and third haplo-HSCT. For the rest of the pts (after day +30) the HC was related to BKPyV infection, as a consequence of the immunosuppression state of the patient, we also observed all these pts had positive serum viral load for CMV.

Conclusion

The incidence of HC associated to post-HSCT high Cy dose in our series is 15% lower than other ones. Most of them on grade 1 or 2 and without mortality associated.
The risk of HC is high, particularly in the setting of highly pre-treated patients (especially those undergoing a 2nd transplant). The development of HC after day +30 is evidently associated to BKPyV as a contributing factor for continuous inflammation and CMV reactivation (as an immunosuppression marker).
In our study, HC did not have an impact on mortality of high-risk patients after haplo-HSCT. The HC remains frequent with a high morbidity in particular when it is severe, often causing prolonged hospitalization and resource use. We need further studies to recognize the at-risk population early.

Session topic: 22. Stem cell transplantation - Clinical

Keyword(s): Hemorrhagic cystitis, Haploidentical stem cell transplantation

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