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Incidence and risk factor of hemorrhagic cystitis after allogeneic transplantation with fludarabine, busulfan, and anti-thymocyte globulin myeloablative conditioning.
Transpl Infect Dis. 2017 Jun; 19(3)TI

Abstract

BACKGROUND

Hemorrhagic cystitis (HC) is a complication of allogeneic stem cell transplantation (SCT), associated with factors such as BK polyomavirus reactivation, age, conditioning regimen, and presence of graft-versus-host disease (GVHD). The incidence and impact of HC in patients receiving fludarabine (Flu), busulfan (Bu), and anti-thymocyte globulin (ATG) conditioning is unknown.

METHODS

We conducted a case-control study of patients undergoing SCT at our center between January 1, 2003 and Dec 31, 2012, to determine the incidence of HC and its effect on patient outcomes including overall survival (OS), relapse, non-relapse mortality (NRM), GVHD, and healthcare resource use.

RESULTS

In total, 94 cases of HC were identified and matched to controls based on age, donor type, disease type, and disease status at transplantation. The total incidence of HC was 17.7% (117 of 661 patients). Cases had a higher rate (43.6% vs 27.1%, P=.0394) of acute GVHD (Grade II-IV), and chronic GVHD requiring systemic steroids (34.9% vs 18.6%, P=.004). Male gender was found to be a risk factor (hazard ratio [HR]=1.725, P=.017). OS and progression-free survival did not differ between cases and controls (OS HR=1.128, 95% confidence interval [CI] 0.7807-1.639; progression-free survival HR=0.8809, 95% CI 0.6320-1.234), however the rate of NRM was higher in cases (HR=1.632, 95% CI 1.007-2.830). Median length of hospitalization was longer for patients with HC than matched controls (65.5 days vs 40.5 days, P<.0001).

CONCLUSION

HC is common in patients undergoing allogeneic SCT with FluBuATG conditioning, and affects the duration of hospitalization. Rate of GVHD is higher among patients with HC. While OS is not affected, an association was seen with higher NRM in our study. Improvement in treatment for HC may lead to reductions in morbidity and healthcare resource utilization.

Authors+Show Affiliations

Division of Hematology and Hematologic Malignancies, University of Calgary, Calgary, AB, Canada.Division of Hematology and Hematologic Malignancies, University of Calgary, Calgary, AB, Canada.Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, AB, Canada.Division of Hematology and Hematologic Malignancies, University of Calgary, Calgary, AB, Canada.Division of Hematology and Hematologic Malignancies, University of Calgary, Calgary, AB, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28199755

Citation

Lam, Wilson, et al. "Incidence and Risk Factor of Hemorrhagic Cystitis After Allogeneic Transplantation With Fludarabine, Busulfan, and Anti-thymocyte Globulin Myeloablative Conditioning." Transplant Infectious Disease : an Official Journal of the Transplantation Society, vol. 19, no. 3, 2017.
Lam W, Storek J, Li H, et al. Incidence and risk factor of hemorrhagic cystitis after allogeneic transplantation with fludarabine, busulfan, and anti-thymocyte globulin myeloablative conditioning. Transpl Infect Dis. 2017;19(3).
Lam, W., Storek, J., Li, H., Geddes, M., & Daly, A. (2017). Incidence and risk factor of hemorrhagic cystitis after allogeneic transplantation with fludarabine, busulfan, and anti-thymocyte globulin myeloablative conditioning. Transplant Infectious Disease : an Official Journal of the Transplantation Society, 19(3). https://doi.org/10.1111/tid.12677
Lam W, et al. Incidence and Risk Factor of Hemorrhagic Cystitis After Allogeneic Transplantation With Fludarabine, Busulfan, and Anti-thymocyte Globulin Myeloablative Conditioning. Transpl Infect Dis. 2017;19(3) PubMed PMID: 28199755.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence and risk factor of hemorrhagic cystitis after allogeneic transplantation with fludarabine, busulfan, and anti-thymocyte globulin myeloablative conditioning. AU - Lam,Wilson, AU - Storek,Jan, AU - Li,Haocheng, AU - Geddes,Michelle, AU - Daly,Andrew, Y1 - 2017/04/17/ PY - 2016/04/28/received PY - 2016/08/18/revised PY - 2016/11/09/revised PY - 2016/11/13/accepted PY - 2017/2/16/pubmed PY - 2018/3/27/medline PY - 2017/2/16/entrez KW - BK virus KW - cystitis KW - graft-versus-host disease/complication KW - hematopoietic stem cell transplantation KW - polyomavirus infections/complications JF - Transplant infectious disease : an official journal of the Transplantation Society JO - Transpl Infect Dis VL - 19 IS - 3 N2 - BACKGROUND: Hemorrhagic cystitis (HC) is a complication of allogeneic stem cell transplantation (SCT), associated with factors such as BK polyomavirus reactivation, age, conditioning regimen, and presence of graft-versus-host disease (GVHD). The incidence and impact of HC in patients receiving fludarabine (Flu), busulfan (Bu), and anti-thymocyte globulin (ATG) conditioning is unknown. METHODS: We conducted a case-control study of patients undergoing SCT at our center between January 1, 2003 and Dec 31, 2012, to determine the incidence of HC and its effect on patient outcomes including overall survival (OS), relapse, non-relapse mortality (NRM), GVHD, and healthcare resource use. RESULTS: In total, 94 cases of HC were identified and matched to controls based on age, donor type, disease type, and disease status at transplantation. The total incidence of HC was 17.7% (117 of 661 patients). Cases had a higher rate (43.6% vs 27.1%, P=.0394) of acute GVHD (Grade II-IV), and chronic GVHD requiring systemic steroids (34.9% vs 18.6%, P=.004). Male gender was found to be a risk factor (hazard ratio [HR]=1.725, P=.017). OS and progression-free survival did not differ between cases and controls (OS HR=1.128, 95% confidence interval [CI] 0.7807-1.639; progression-free survival HR=0.8809, 95% CI 0.6320-1.234), however the rate of NRM was higher in cases (HR=1.632, 95% CI 1.007-2.830). Median length of hospitalization was longer for patients with HC than matched controls (65.5 days vs 40.5 days, P<.0001). CONCLUSION: HC is common in patients undergoing allogeneic SCT with FluBuATG conditioning, and affects the duration of hospitalization. Rate of GVHD is higher among patients with HC. While OS is not affected, an association was seen with higher NRM in our study. Improvement in treatment for HC may lead to reductions in morbidity and healthcare resource utilization. SN - 1399-3062 UR - https://www.unboundmedicine.com/medline/citation/28199755/Incidence_and_risk_factor_of_hemorrhagic_cystitis_after_allogeneic_transplantation_with_fludarabine_busulfan_and_anti_thymocyte_globulin_myeloablative_conditioning_ L2 - https://doi.org/10.1111/tid.12677 DB - PRIME DP - Unbound Medicine ER -