Safety and cost of hyperhydration for the prevention of hemorrhagic cystitis in bone marrow transplant recipients

Hemorrhagic cystitis is a major cause of morbidity after bone marrow transp lantation. Traditional methods of prevention have included mesna (2-mercapt oethane sodium sulfonate) and bladder irrigation. We report the use of hype rhydration as an alternative to these prophylactic measures. One hundred co nsecutive patients who underwent autologous or allogeneic bone marrow trans plantation received high dose cyclophosphamide with hyperhydration using 5% dextrose normal saline at the rate of 250 ml/h and furosemide to maintain a urine output of >150 ml/h. Seventy-one of these patients also received hi gh dose cyclophosphamide as mobilization chemotherapy. There were no episod es of hemorrhagic cystitis following mobilization chemotherapy. The inciden ce of hemorrhagic cystitis after transplant conditioning was 7% with 2 pati ents developing clinically significant hemorrhagic cystitis; one was a seve re episode. The cost of hyperhydration was US$ 20 per course as opposed to US$ 1,500 per course for mesna, based on acquisition costs at our instituti on. We conclude that hyperhydration is a safe, inexpensive means of prevent ing hemorrhagic cystitis associated with high dose cyclophosphamide in bone marrow transplant recipients. Copyright (C) 1999 S. Karger AG, Basel.