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Cystectomy for severe hemorrhagic cystitis in allogeneic stem cell transplant recipients
L Garderet1, H Bittencourt, P Sebe
1Department of Bone Marrow Transplantation, Saint Louis Hospital, Paris, France.
Insights
Severe hemorrhagic cystitis (HC) after stem cell transplantation (SCT) can be life-threatening. In rare cases, cystectomy may be required as a life-saving procedure for prolonged HC.
Area of Science:
- Hematology
- Transplantation Medicine
- Urology
Background:
- Hemorrhagic cystitis (HC) is a frequent complication post-allogeneic stem cell transplantation (SCT).
- Severe HC can lead to kidney failure, sepsis, and be life-threatening.
Observation:
- Three cases of severe HC in stem cell transplant recipients are presented.
- Patients received high-dose cyclophosphamide with total body irradiation or busulfan.
- BK viruria was detected in two patients at hematuria onset.
Findings:
- Severe HC persisted for over 3 months in these patients.
- Complications included urinary tract obstruction and sepsis.
- Cystectomy was ultimately performed as a life-saving intervention.
Implications:
- This case series highlights cystectomy as a critical, last-resort treatment for life-threatening, refractory hemorrhagic cystitis post-SCT.
- Understanding risk factors and management is crucial for severe HC cases.
Background:
Hemorrhagic cystitis (HC) is a common complication following allogeneic 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 recipients. Risk factors and the management of these patients were studied, as well 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 underwent 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 than 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 patients treated in our unit by allogeneic bone marrow transplantation, in whom HC was severe and long lasting enough to require cystectomy as a life-saving procedure.