Cystectomy for severe hemorrhagic cystitis in allogeneic stem cell transplant recipients

Background. Hemorrhagic cystitis (HC) is a common complication following al logeneic stem cell transplantation (SCT). In rare cases, it can be severe, inducing kidney failure and sepsis, and become life-threatening. Methods. We report three cases of severe HC in stem cell transplant recipie nts. Risk factors and the management of these patients were studied, as wel l as severe HC cases reported in the literature. Results. All three patients received high-dose cyclophosphamide in addition to total body irradiation or busulfan in their preparative regimen. They u nderwent allogeneic SCT, one of them from unrelated cord blood. BK viruria was detected in two cases at the onset of hematuria, HC lasted for more tha n 3 months, resulting in urinary tract obstruction and sepsis, Ultimately, cystectomy was the last therapeutic procedure available to treat this life- threatening complication. Conclusion. We describe three patients, among a total of more than 1300 pat ients treated in our unit by allogeneic bone marrow transplantation, in who m HC was severe and long lasting enough to require cystectomy as a life-sav ing procedure.