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Related Experiment Videos

Hemorrhagic cystitis complicating bone marrow transplantation.

L Letendre1, H C Hoagland, M A Gertz

  • 1Division of Hematology, Mayo Clinic, Rochester, MN 55905.

Mayo Clinic Proceedings
|February 1, 1992
PubMed
Summary

Mesna uroprophylaxis for preventing hemorrhagic cystitis after high-dose cyclophosphamide before bone marrow transplant was less effective than standard hydration and bladder irrigation. Standard methods remain preferred for reducing this complication.

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Area of Science:

  • Oncology
  • Hematology
  • Urology

Background:

  • Hemorrhagic cystitis is a serious complication of high-dose cyclophosphamide therapy before bone marrow transplantation.
  • Standard prophylaxis includes forced hydration and bladder irrigation to mitigate this risk.
  • Mesna is a uroprotective agent that neutralizes cyclophosphamide's toxic metabolites.

Purpose of the Study:

  • To evaluate the feasibility and efficacy of mesna uroprophylaxis compared to standard prophylaxis for preventing hemorrhagic cystitis.
  • To assess if mesna could replace bladder irrigation, reducing patient inconvenience.

Main Methods:

  • A feasibility trial was conducted comparing mesna uroprophylaxis to standard hydration and bladder irrigation.
  • Patients received high-dose cyclophosphamide prior to allogeneic bone marrow transplantation.

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  • Outcomes measured included the incidence and severity of hemorrhagic cystitis.

    • Main Results:

    • Of 97 patients receiving standard prophylaxis, 4 developed symptomatic hemorrhagic cystitis.
    • In contrast, 2 of 4 patients receiving mesna uroprophylaxis experienced severe hemorrhagic cystitis lasting at least 2 weeks.
    • The incidence of severe hemorrhagic cystitis was higher in the mesna group.

    Conclusions:

    • Mesna uroprophylaxis demonstrated suboptimal results in preventing hemorrhagic cystitis in this cohort.
    • Standard hydration and bladder irrigation were more effective in minimizing the risk of hemorrhagic cystitis.
    • The use of bladder irrigation was resumed due to the superior efficacy of standard prophylaxis.