Severe cyclophosphamide-induced haemorrhagic cystitis treated with hyperbaric oxygen

Cyclophosphamide-induced haemorrhagic cystitis (CHC) is an uncommon but well-recognised condition caused by a metabolite, acrolein, which is toxic to the urothelium. Based on similarities in the histopathology of radiation- and chemotherapy-induced haemorrhagic cystitis, benefit from hyperbaric oxygen therapy (HBOT) has been proposed. HBOT produces an increased oxygen partial pressure diffusion gradient between the circulation and surrounding tissues, which enhances neutrophil function and fibroblast and macrophage migration into damaged hypoxic soft tissue, promoting collagen formation, fibroblast growth, angiogenesis and white-cell bacterial killing. There are only isolated case reports of HBOT for CHC, in the literature so we reviewed the New Zealand experience with HBOT in CHC.

The case records of all patients with CHC referred to the three hyperbaric medicine units in New Zealand between 2000 and 2007 were reviewed retrospectively.

Six patients, with life-threatening haemorrhage at the time of referral for HBOT weeks or months after initial presentation with CHC, were identified. Cessation of bleeding occurred in all six patients after 14 to 40 HBOT, without complications. All patients remained clear of haematuria at 11 to 36 months follow-up.

We recommend the use of HBOT in the management of intractable cyclophosphamide-induced haemorrhagic cystitis as an effective and low-risk therapy.