Risk factors associated with hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation

Biao Shen; Yueshen Ma; Haixiao Zhang; Mingyang Wang; Jia Liu; Jiaxin Cao; Wenwen Guo; Dan Feng; Donglin Yang; Rongli Zhang; Xin Chen; Qiaoling Ma; Weihua Zhai; Sizhou Feng; Mingzhe Han; Aiming Pang; Erlie Jiang

doi:10.1097/BS9.0000000000000110

Risk factors associated with hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation

Blood Sci. 2022 May 17;4(2):83-88. doi: 10.1097/BS9.0000000000000110. eCollection 2022 Apr.

Authors

Biao Shen¹, Yueshen Ma², Haixiao Zhang¹, Mingyang Wang¹, Jia Liu¹, Jiaxin Cao¹, Wenwen Guo¹, Dan Feng¹, Donglin Yang¹, Rongli Zhang¹, Xin Chen¹, Qiaoling Ma¹, Weihua Zhai¹, Sizhou Feng¹, Mingzhe Han¹, Aiming Pang¹, Erlie Jiang¹

Affiliations

¹ State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College and Chinese Academy, Tianjin, China.
² Administration Office of Biostatistics, Center for Information and Resources, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College and Chinese Academy, Tianjin, China.

Abstract

Hemorrhagic cystitis (HC) is a common complication of allogeneic hematopoietic stem cell transplantation (HSCT). The incidence is about 7% to 68%, and some patients have to suffer a long period of frequent, urgent, and painful urination, which brings great pain. This study aimed to analyze risk factors of HC and its effect on patient survival. We collected the medical records of 859 patients who underwent HSCT at our hospital between August 2016 and August 2020. Patients with and without HC were matched using propensity score matching at a 1:1 ratio based on sex, age, and diagnosis, and logistic regression analyses were used to identify factors associated with HC. We used Kaplan-Meier curves to analyze the survival rates of patients in the HC and non-HC groups. We also analyzed the relationship between BK viral load and the occurrence of HC using receiver operating characteristic curve (ROC) analysis. After propensity score matching, there were 131 patients each in the HC and non-HC groups. In the HC group, 89 patients (67.9%) had mild HC (stage II°) and 43 (32.1%) had severe HC (stage III-IV). The median interval between stem cell transplantation and HC development was 31 (3-244) days. Univariate analysis indicated that donor age, hematopoietic stem cell source, HLA, acute graft-versus-host disease, busulfan, anti-thymocyte globulin (ATG), total body irradiation, cytomegalovirus (CMV) (urine), and BK polyomavirus (BKV) (urine) were significantly associated with HC. ATG, CMV (urine), and BKV (urine) were independent risk factors for HC based on the multivariate analysis. The Kaplan-Meier survival analysis showed no significant difference between the HC and non-HC groups (P = .14). The 1- and 2-year survival rates in the HC group were 78.4% and 69.6%, respectively, and the corresponding rates in the non-HC group were 84.4% and 80.7%, respectively. ROC analysis indicated that a urine BKV load of 1 × 10⁷ copies/mL was able to stratify the risk of HC. In conclusion, when the BKV load is >1 × 10⁷, we need to be aware of the potential for the development of HC.

Keywords: Allogeneic hematopoietic stem cell transplantation; Hemorrhagic cystitis; Prognosis; Risk factors.

Copyright © 2022 The Authors. Published by Wolters Kluwer Health Inc., on behalf of the Chinese Medical Association (CMA) and Institute of Hematology, Chinese Academy of Medical Sciences & Peking Union Medical College (IHCAMS).