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Updated: Jan 17, 2026
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Published on: February 25, 2007
Hemorrhagic Cystitis Following Hematopoietic Stem Cell Transplantation in Children: A Single Pediatric Center
Pauline Mazilier1, Laurence Dedeken1, Eleonore Powis2
1Department of Pediatric Oncology and Bone Marrow Transplantation, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium.
Insights
Hemorrhagic cystitis (HC) is a common complication after pediatric stem cell transplants. Early intervention and multidisciplinary care are crucial for managing this condition and improving patient outcomes.
Area of Science:
- Pediatric Hematology/Oncology
- Transplantation Medicine
- Infectious Diseases
Background:
- Hemorrhagic cystitis (HC) is a frequent and severe complication post-pediatric hematopoietic stem cell transplantation (HSCT).
- Current management lacks standardized guidelines, impacting quality of life and hospital stays.
Purpose of the Study:
- To characterize HC in pediatric HSCT patients.
- Identify risk factors, treatments, and outcomes.
- Inform future management strategies.
Main Methods:
- Retrospective single-center study of pediatric allogeneic HSCT recipients (2007-2022).
- HC defined and graded using ECIL guidelines.
- Analysis included risk factors, BK virus (BKV) viruria, treatments, and outcomes.
Main Results:
- HC occurred in 14.7% of patients, median onset 27.5 days post-HSCT.
- Acute graft-versus-host disease (aGVHD) significantly associated with HC (p=0.01).
- BKV detected in 66.7% of cases; cidofovir used in 79.2%. Severe HC required multimodal therapy (HBO, embolization). No HC-attributed deaths.
Conclusions:
- HC is a significant complication post-pediatric HSCT.
- Early identification of high-risk patients and multidisciplinary interventions are vital.
- Multicenter studies needed to standardize care and improve outcomes.
Background:
Hemorrhagic cystitis (HC) is a frequent and potentially severe complication following hematopoietic stem cell transplantation (HSCT) in children. It significantly affects the quality of life and prolongs hospitalization. Despite its frequency, no standardized management guidelines exist. This study aimed to describe the characteristics, risk factors, and treatments of HC in a pediatric HSCT population.
Methods:
We conducted a retrospective single-center study including all pediatric patients who underwent allogeneic HSCT between January 2007 and December 2022. HC was defined and graded according to the European Conference on Infections in Leukaemia (ECIL) guidelines. We analyzed risk factors, BK virus (BKV) viruria, treatments, and outcomes.
Results:
HC occurred in 24 patients (14.7%), with a median onset at 27.5 days post-HSCT. Acute graft-versus-host disease (aGVHD) was significantly associated with HC occurrence (45.8% vs. 19.4%, p = 0.01), particularly in its severe forms (p = 0.007). BKV was detected in 66.7% of HC cases. Viral load in urine was not significantly associated with HC severity or duration. All patients received supportive care; cidofovir was used in 79.2%, with increasing frequency in higher grade HC. Severe cases required multimodal management, including intravesical installations, hyperbaric oxygen therapy (HBO; 37.5%), and arterial embolization (all Grade 4 cases). No deaths were directly attributed to HC.
Conclusions:
HC remains a significant and morbid complication after pediatric HSCT. Our findings highlight the need for early identification of high-risk patients and access to timely, multidisciplinary interventions. Multicenter prospective studies are essential to standardize care and improve outcomes in this vulnerable population.
