Lam, Wilson;
Storek, Jan;
Li, Haocheng;
Geddes, Michelle;
Daly, Andrew
Incidence and risk factor of hemorrhagic cystitis after allogeneic transplantation with fludarabine, busulfan, and anti‐thymocyte globulin myeloablative conditioning
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Media type:
E-Article
Title:
Incidence and risk factor of hemorrhagic cystitis after allogeneic transplantation with fludarabine, busulfan, and anti‐thymocyte globulin myeloablative conditioning
Description:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Hemorrhagic cystitis (<jats:styled-content style="fixed-case">HC</jats:styled-content>) is a complication of allogeneic stem cell transplantation (<jats:styled-content style="fixed-case">SCT</jats:styled-content>), associated with factors such as <jats:styled-content style="fixed-case">BK</jats:styled-content> polyomavirus reactivation, age, conditioning regimen, and presence of graft‐versus‐host disease (<jats:styled-content style="fixed-case">GVHD</jats:styled-content>). The incidence and impact of <jats:styled-content style="fixed-case">HC</jats:styled-content> in patients receiving fludarabine (Flu), busulfan (Bu), and anti‐thymocyte globulin (<jats:styled-content style="fixed-case">ATG</jats:styled-content>) conditioning is unknown.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a case‐control study of patients undergoing <jats:styled-content style="fixed-case">SCT</jats:styled-content> at our center between January 1, 2003 and Dec 31, 2012, to determine the incidence of <jats:styled-content style="fixed-case">HC</jats:styled-content> and its effect on patient outcomes including overall survival (<jats:styled-content style="fixed-case">OS</jats:styled-content>), relapse, non‐relapse mortality (NRM), <jats:styled-content style="fixed-case">GVHD</jats:styled-content>, and healthcare resource use.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In total, 94 cases of <jats:styled-content style="fixed-case">HC</jats:styled-content> were identified and matched to controls based on age, donor type, disease type, and disease status at transplantation. The total incidence of <jats:styled-content style="fixed-case">HC</jats:styled-content> was 17.7% (117 of 661 patients). Cases had a higher rate (43.6% vs 27.1%, <jats:italic>P</jats:italic>=.0394) of acute <jats:styled-content style="fixed-case">GVHD</jats:styled-content> (Grade <jats:styled-content style="fixed-case">II</jats:styled-content>‐<jats:styled-content style="fixed-case">IV</jats:styled-content>), and chronic <jats:styled-content style="fixed-case">GVHD</jats:styled-content> requiring systemic steroids (34.9% vs 18.6%, <jats:italic>P</jats:italic>=.004). Male gender was found to be a risk factor (hazard ratio [<jats:styled-content style="fixed-case">HR</jats:styled-content>]=1.725, <jats:italic>P</jats:italic>=.017). <jats:styled-content style="fixed-case">OS</jats:styled-content> and progression‐free survival did not differ between cases and controls (<jats:styled-content style="fixed-case">OS HR</jats:styled-content>=1.128, 95% confidence interval [<jats:styled-content style="fixed-case">CI</jats:styled-content>] 0.7807‐1.639; progression‐free survival <jats:styled-content style="fixed-case">HR</jats:styled-content>=0.8809, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.6320‐1.234), however the rate of NRM was higher in cases (<jats:styled-content style="fixed-case">HR</jats:styled-content>=1.632, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.007‐2.830). Median length of hospitalization was longer for patients with <jats:styled-content style="fixed-case">HC</jats:styled-content> than matched controls (65.5 days vs 40.5 days, <jats:italic>P</jats:italic><.0001).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p><jats:styled-content style="fixed-case">HC</jats:styled-content> is common in patients undergoing allogeneic <jats:styled-content style="fixed-case">SCT</jats:styled-content> with FluBu<jats:styled-content style="fixed-case">ATG</jats:styled-content> conditioning, and affects the duration of hospitalization. Rate of <jats:styled-content style="fixed-case">GVHD</jats:styled-content> is higher among patients with <jats:styled-content style="fixed-case">HC</jats:styled-content>. While <jats:styled-content style="fixed-case">OS</jats:styled-content> is not affected, an association was seen with higher NRM in our study. Improvement in treatment for <jats:styled-content style="fixed-case">HC</jats:styled-content> may lead to reductions in morbidity and healthcare resource utilization.</jats:p></jats:sec>