Retrospectively evaluation of characteristics and treatment ofhemorrhagic cystitis cases in post transplantation followup period inallogeneik hematopoetik bone marrow transplantation recipients

Hemorrhagic cystitis frequently occurs after allogeneic hematologic stem cell transplantation. For allogeneic hematologic stem cell transplantation patients, it is an important cause of morbidity and rarely mortality. We aimed to determine prevelance, risk factors, treatments given, treatment response rates and effects of disease free survival of hemorrhagic cystitis by retrospectively analyzing our patients with hematological malignancy who underwent allogeneic hematopoietic stem cell transplantation. We were retrospectively examined 110 patients with hematological malignancy who underwent allogeneic hematopoietic stem cell transplantation in the Bursa Uludag Univercity Faculty of Medicine Internal Medicine Department, Hematology Department Stem Cell Transplantation Unit between 2011 and 2019. Hemorrhagic cystitis developed in 34 (30.9%) of 110 patients. Among these patients 14 was detected early hemorrhagic cystitis (41.2%) and 20 was detected late hemorrhagic cystitis (58.8%). The mean time to hemorrhagic cystitis development was 32.5 days (-2-226). There is manageable toxicity (grade 1 or 2) in 24 patients (70.6%) and severe toxicity (grade 3 or 4) in 10 (29.4%) patients. In univariate analysis, transplant age, gender, acute gvhd, transplant regimen, donor recipient gender compatibility, CMV history, steroid usage and primary disease was evaluated for risk factors. None of them were detected as significant risk factors. Patients with hemorrhagic cystitis were administered intravenous hydration therapy. Irrigation with intrabladder foley catheter was performed in vi 9 patients (26.5%). Cidofovir treatment was used for 8 of 10 patients with BK virüs. Valgancyclovir of gancyclovir treatment was used for 8 patients with CMV. Advanced urological procedures suc as coagulum emptying and coetherization from bladder was needed for 4 patients with class 4 hemorrhagic cystitis. Patients with hemorrhagic cystitis were treated for and average of 28 days (3-190). Treatment response was not obtained in 2 patients (5.9%). While hemorrhagic cystitis development was found as a risk factor for overall survival in mortality analysis, mortality risk was 1.82 fold higher in patients with hemorrhagic cystitis than patients that not developed hemorrhagic cystitis. In conclusion, it increased the mortality risk of hemorrhagic cystitis development in allogeneic hematopoietic transplant recipient. In order to minimize the mortality, it requires to identify of the causes of hemorrhagic cystitis and constitute a standart treatment protocol. Prospective studies with large samples was needed to obtaining these achievements. Key Words: Allogeneic stem cell transplantation, hemorrhagic cystitis, BK virüs