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Incidence and risk factor of hemorrhagic cystitis after allogeneic transplantation with fludarabine, busulfan, and anti‐thymocyte globulin myeloablative conditioning
Author(s) -
Lam Wilson,
Storek Jan,
Li Haocheng,
Geddes Michelle,
Daly Andrew
Publication year - 2017
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.12677
Subject(s) - medicine , busulfan , hazard ratio , anti thymocyte globulin , fludarabine , incidence (geometry) , gastroenterology , hemorrhagic cystitis , transplantation , cumulative incidence , regimen , risk factor , graft versus host disease , surgery , hematopoietic stem cell transplantation , confidence interval , chemotherapy , cyclophosphamide , physics , optics
Background Hemorrhagic cystitis ( HC ) is a complication of allogeneic stem cell transplantation ( SCT ), associated with factors such as BK polyomavirus reactivation, age, conditioning regimen, and presence of graft‐versus‐host disease ( GVHD ). The incidence and impact of HC in patients receiving fludarabine (Flu), busulfan (Bu), and anti‐thymocyte globulin ( ATG ) conditioning is unknown. Methods We conducted a case‐control study of patients undergoing SCT at our center between January 1, 2003 and Dec 31, 2012, to determine the incidence of HC and its effect on patient outcomes including overall survival ( OS ), relapse, non‐relapse mortality (NRM), GVHD , and healthcare resource use. Results In total, 94 cases of HC were identified and matched to controls based on age, donor type, disease type, and disease status at transplantation. The total incidence of HC was 17.7% (117 of 661 patients). Cases had a higher rate (43.6% vs 27.1%, P =.0394) of acute GVHD (Grade II ‐ IV ), and chronic GVHD requiring systemic steroids (34.9% vs 18.6%, P =.004). Male gender was found to be a risk factor (hazard ratio [ HR ]=1.725, P =.017). OS and progression‐free survival did not differ between cases and controls ( OS HR =1.128, 95% confidence interval [ CI ] 0.7807‐1.639; progression‐free survival HR =0.8809, 95% CI 0.6320‐1.234), however the rate of NRM was higher in cases ( HR =1.632, 95% CI 1.007‐2.830). Median length of hospitalization was longer for patients with HC than matched controls (65.5 days vs 40.5 days, P <.0001). Conclusion HC is common in patients undergoing allogeneic SCT with FluBu ATG conditioning, and affects the duration of hospitalization. Rate of GVHD is higher among patients with HC . While OS is not affected, an association was seen with higher NRM in our study. Improvement in treatment for HC may lead to reductions in morbidity and healthcare resource utilization.