PREVENTION OF HEMORRHAGIC CYSTITIS AFTER HIGH-DOSE ALKYLATING AGENT CHEMOTHERAPY AND AUTOLOGOUS BONE-MARROW SUPPORT

High-dose cyclophosphamide (CY) is associated with a high risk of hemo rrhagic cystitis. The reported frequency ranges from 6.5 to 52% despit e the use of hydration protocols. The current study reports a hyperhyd ration and continuous bladder irrigation protocol which resulted in a very low incidence of microscopic hematuria and no reported cases of v isible hematuria. Patients received baseline fluids at 200 ml/m(2)/h d uring chemotherapy. Additional fluid boluses were given if urine outpu t fell below 200 ml/h. Bladder irrigation was performed at a rate of 1 l/h during and for 24 h after high-dose CY. Three hundred three evalu able patients with solid tumors received high-dose chemotherapy with C Y at a dose of 5625 mg/m(2) over 3 days. Patients also received cispla tin 165 mg/m(2) and carmustine 600 mg/m(2). Some patients received thi otepa 300-750 mg/m(2) instead of carmustine. The overall incidence of microscopic hematuria (> 15 RBCs per high power field) was 19%, with o nly 11% of patients experiencing more than 50 RBCs per high power fiel d. No patient developed visible hematuria or symptomatic hematuria req uiring intervention. These results using aggressive hyperhydration and high volumes of continuous bladder irrigation are among the best repo rted following high-dose CY chemotherapy.