INTRAVESICULAR CARBOPROST FOR THE TREATMENT OF HEMORRHAGIC CYSTITIS AFTER MARROW TRANSPLANTATION

Objectives. To determine the minimal active dose and extent of activit y of intravesicular carboprost for the treatment of hemorrhagic cystit is after marrow transplantation. Methods. Twenty-four adults with grad e 3 or 4 hemorrhagic cystitis were treated. All but 2 had failed other local therapy. Treatment was initiated at a median of 32 days post-tr ansplant. Eleven patients received carboprost intravesicularly at 0.2 mg/dL for 60 minutes every 6 hours, and the dose was escalated every 2 4 hours until a dose of 1.0 mg/dL was reached unless a response was ac hieved. Thirteen additional patients were treated at an initial dose o f 0.8 mg/dL, with escalation to 1.0 mg/dL after four doses in the abse nce of a response. Results. Overall, 15 of the 24 patients responded. In the dose-escalation setting, 0.8 mg/dL was the minimal active dose. The total response rate was 62% with doses at or above 0.8 mg/dL and 18% at lower doses. Ail but one response occurred with 7 or fewer days of therapy, and 9 patients relapsed later. Four additional patients w ere salvaged following cystoscopy with clot evacuation with or without alum or formalin instillation. In all but 1 patient, bladder spasms d eveloped during treatment with carboprost, but were not sufficiently s evere to discontinue therapy. Conclusions. Intravesicular carboprost a t 1.0 mg/dL every 6 hours for no more than 7 days should be considered for a randomized study for treatment of refractory hemorrhagic cystit is. Cystoscopic examination and evacuation of clots prior to therapy m ay be required to achieve the full benefit of this treatment.