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Cyclophosphamide‐induced hemorrhagic cystitis in young patients with solid tumors: A single institution study
Author(s) -
Saito Yoshimasa,
Kumamoto Tadashi,
Shiraiwa Miki,
Sonoda Tomoko,
Arakawa Ayumu,
Hashimoto Hironobu,
Tamai Ikumi,
Ogawa Chitose,
Terakado Hiroyuki
Publication year - 2018
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/ajco.13048
Subject(s) - mesna , hemorrhagic cystitis , medicine , cyclophosphamide , chemotherapy , complication , urology , gastroenterology , surgery , ifosfamide , etoposide
Abstract Aim Although hemorrhagic cystitis (HC) is a significant complication in young patients who undergo chemotherapy with cyclophosphamide (CPA), risk factors and supportive care to prevent HC are unclear. This study attempted to identify optimal supportive care to prevent CPA‐induced HC. Methods Patients (< 30‐year‐old) with malignant solid tumors who had been treated with CPA‐containing chemotherapy in inpatient treatment were eligible. Vigorous hydration to increase urine output and intravenous 2‐mercaptethane sulfonate (mesna) were used for prophylaxis of CPA‐induced HC. We retrospectively analyzed 81 patients who had been treated with CPA‐containing chemotherapy over (collectively) 486 cycles, and examined relationships between HC and various factors, especially CPA dosage, use of mesna, and fluid infusion volume/rate. Results HC occurred in four patients (4.9%) and five cycles (1%). When stratifying by doses and methods of administration of CPA, HC occurred in 3/323 low‐ and intermediate‐dose (< 1500 mg/m 2 /day) cycles and mesna was used in all three cycles with HC. Patients who were given mesna had a lower flow rate than those given hydration alone in the low‐ and intermediate‐dose CPA (126 ± 25 vs 106 ± 16 mL/m 2 /h; P < 0.01). All patients who received high‐dose CPA (≥1500 mg/m 2 /day) were also given mesna and vigorous hydration (115 ± 16 mL/m 2 /h). Conclusions Our supportive care measures may be effective in preventing CPA‐induced HC. Patients who receive CPA doses < 1500 mg/m 2 /day should get ≥125 mL/m 2 /h of infused fluid, regardless of mesna usage; those who receive of CPA ≥1500 mg/m 2 /day should also receive mesna and vigorous hydration.