Hemorrhagic Cystitis After Allo SCT; Donor Type Matters

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Blood First Edition Paper, prepublished online January 15, 2004

Submitted August 18, 2003

Accepted December 1, 2003

Hemorrhagic cystitis after allogeneic hematopoietic stem cell

transplantation: donor type matters

Maha El-Zimaity, Rima Saliba, Kawah Chan, Munir Shahjahan,

Carrasco, Ola Khorshid, Humberto Caldera, Couriel,

Giralt, Issa Khouri, Ippoliti, Champlin, and Marcos de

Lima*

Department of Blood and Marrow Transplantation, University of Texas

MD Cancer Center, Houston, TX, USA

Hemorrhagic cystitis (HC) remains a common complication of allogeneic

blood and marrow transplantation.

Previous analyses of risk factors for this complication were

performed in heterogenous populations, with dissimilar diagnosis and

conditioning regimens. We postulated that HC is more prevalent in

matched unrelated donor (MUD) and unrelated cord blood (UCB)

transplants than in matched related donor (MRD) transplants.

Retrospective study on 105 acute lymphocytic leukemia patients

treated with 12 Gy total body irradiation based regimens and

allogeneic transplants (MUD n=38; UCB, n=15; mismatched related, n=20

MRD, n=32). HC occurred in 16% of patients receiving MRD transplants,

30% of recipients of mismatched related, and 40% of MUD or UCB

transplants (Hazard ratio 2.9, 95%CI 1.0-7.9 for the comparison of

MRD versus MUD).

The excessive rate of HC among MUD and UCB patients became evident

after the first 30 days post transplant. Recipients younger than 26

years had a significantly higher incidence of HC (HR 2.5, 95%CI 1.1-

5.8). This donor type and age effect was independent of platelet

engraftment, development of GVHD, source of stem cells, use of ATG

and cyclophosphamide in the regimen, steroid use, or stem cell

source.

We concluded that HC is more prevalent in MUD and UCB transplants.