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Incidence and risk factors for hemorrhagic cystitis in unmanipulated haploidentical transplant recipients
Author(s) -
Ruggeri A.,
RothGuepin G.,
Battipaglia G.,
Mamez A.C.,
Malard F.,
Gomez A.,
Brissot E.,
Belhocine R.,
Vekhoff A.,
Lapusan S.,
Isnard F.,
Legrand O.,
Gozlan J.,
Boutolleau D.,
Ledraa T.,
Labopin M.,
Rubio M.T.,
Mohty M.
Publication year - 2015
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12455
Subject(s) - medicine , hemorrhagic cystitis , cumulative incidence , incidence (geometry) , gastroenterology , cyclophosphamide , hematopoietic stem cell transplantation , immunosuppression , complication , mycophenolate , transplantation , surgery , chemotherapy , physics , optics
Background Hemorrhagic cystitis ( HC ) is a common complication after hematopoietic allogeneic stem cell transplantation ( HSCT ) associated with intensity of the conditioning regimen, cyclophosphamide (Cy) therapy, and BK polyomavirus ( BKP yV) infection. Methods We analyzed 33 consecutive haploidentical (haplo) HSCT recipients transplanted for hematologic diseases. Eleven patients had a previous transplant. Median follow‐up was 11 months. Graft‐versus‐host disease ( GVHD ) prophylaxis consisted of cyclosporine + mycophenolate mofetil and post‐ HSCT Cy. Results Thirty‐two of 33 patients achieved neutrophil recovery. Cumulative incidence ( CI ) of platelet recovery was 65%. CI grade II – IV acute GVHD was 44%. Twenty patients developed HC in a median time of 38 days. CI of HC at day 180 was 62%. BKP yV was positive in blood and urine of 91% of patients at HC onset. HC resolved in 18/20 patients. Factors associated with HC were previous transplant ( P = 0.01) and occurrence of cytomegalovirus reactivation before HC ( P = 0.05). Grade II – IV acute GVHD was not associated with HC ( P = 0.62). CI of day 180 viral infections was 73%. Two‐year overall survival (OS) was 50%; HC did not impact OS ( P = 0.29). Conclusion The incidence of HC after haplo with post‐ HSCT Cy is high and is associated with morbidity, especially in high‐risk patients such as those with a previous transplant history and with impaired immune reconstitution.