Hemorrhagic cystitis after conditioning for bone marrow transplantation and its prophylaxis

The situation regarding hemorrhagic cystitis after conditioning for bone marrow transplantation (BMT) in Japan was surveyed and analyzed. Thirty-seven of 110 patients (33.6%) developed hemorrhagic cystitis after conditioning for BMT with cyclophosphamide (CY) and total body irradiation. In two of these 37 patients the cystitis was virus (adenovirus)-induced. In the others it was diagnosed as CY-induced. The severity and duration of CY-induced hemorrhagic cystitis were related to its onset. The delayed type of hemorrhagic cystitis induced by CY seemed to have a poor prognosis and often continued until the patient died. Therefore, late-onset hemorrhagic cystitis should be followed carefully and its prophylaxis may be important. 2-Mercaptoethane sulphonate (mesna) injections for prophylaxis of CY-induced hemorrhagic cystitis were found to be effective in reducing the incidence of the delayed type in 21 (53.8%) of 39 patients treated, but did not reduce the total incidence of CY-induced hemorrhagic cystitis.