HEMORRHAGIC CYSTITIS AFTER BONE-MARROW TRANSPLANTATION - RISK-FACTORSAND COMPLICATIONS

Hemorrhagic cystitis (HC) is a major cause of morbidity after BMT; we have analyzed its incidence, risk factors, and complications in 977 pa tients undergoing BMT between 1974 and 1988. Despite vigorous hydratio n and frequent voiding in all patients receiving cyclophosphamide, 135 /977 (15% by Kaplan-Meier projection) developed HC (micro- or gross he maturia, dysuria, bladder pain) between -11 and +100 days (median +22) after BMT. Of these, 60 had severe HC, including major urinary obstru ction (4/60), renal failure (13/60), or need for surgical or chemical bladder cauterization (16/60). By univariate analysis, allogeneic BMT recipients had more frequent HC than autologous patients (17% vs. 9%, P=0.002). In addition, allogeneic patients with adenoviruria were at i ncreased risk for the development of HC. Patients with aplastic anemia conditioned with high dose cyclophosphamide and total lymphoid irradi ation had the highest rate of HC (22%) versus those with hematologic m alignancies (15%, P=0.03). A Cox proportional hazards regression model was used to further identify those factors independently associated w ith HC. In all regression models, the factor most highly associated wi th the development of HC was the finding of adenovirus in the urine pr eceding the onset of hematuria. HC-related morbidity, and its associat ed increased hospitalization costs, frequently complicates BMT. Improv ed prophylactic measures, perhaps including the use of 2-mercaptoethan e sulfonate, are needed, at least for allogeneic BMT patients with the ir attendant risk of adenovirus infection.