To analyze the risk factors for late-onset hemorrhagic cystitis (LOHC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), the risk factors for the progression of LOHC to severe LOHC, and the effect of LOHC on survival.
Methods: The clinical data of 300 patients who underwent allo-HSCT at the First Affiliated Hospital of Chongqing Medical University from January 2015 to December 2021 were retrospectively analyzed. The relevant clinical parameters that may affect the occurance of LOHC after allo-HSCT were selected for univariate and multivariate analysis. Then, the differences in overall survival (OS) and progression-free survival (PFS) between different groups were analyzed.
Results: The results of multivariate analysis showed that the independent risk factors for LOHC after allo-HSCT were as follows: age≤45 years old (P =0.039), intensified conditioning regimen with fludarabine/cladribine and cytarabine (P =0.002), albumin≤30 g/L on d30 after transplantation (P =0.007), CMV-DNA positive (P =0.028), fungal infection before transplantation (P =0.026), and the occurrence of grade Ⅱ - Ⅳ aGVHD (P =0.006). In the transplant patients who have already developed LOHC, the occurance of LOHC within 32 days after transplantation (P =0.008) and albumin≤30 g/L on d30 after transplantation (P =0.032) were independent risk factors for the progression to severe LOHC. The OS rate of patients with severe LOHC was significantly lower than that of patients without LOHC (P =0.041).
Conclusion: For the patients aged≤45 years old and with intensified conditioning regimen, it is necessary to be vigilant about the occurrence of LOHC; For the patients with earlier occurrence of LOHC, it is necessary to be vigilant that it develops into severe LOHC. Early prevention and treatment of LOHC are essential. Regular monitoring of CMV-DNA and albumin levels, highly effective antiviral and antifungal therapies, and prevention of aGVHD are effective measures to prevent the occurrence and development of LOHC.
题目: 异基因造血干细胞移植后迟发型出血性膀胱炎的危险因素分析.
目的: 分析异基因造血干细胞移植（allo-HSCT）后并发迟发型出血性膀胱炎（LOHC）的危险因素、LOHC发展为重度LOHC的危险因素及LOHC对生存的影响。.
方法: 对2015年1月-2021年12月在重庆医科大学附属第一医院行allo-HSCT的300例患者的临床资料进行回顾性研究，选择可能影响allo-HSCT后LOHC发生的相关临床参数进行单因素和多因素分析，同时分析组间的总生存期（OS）和无进展生存期（PFS）差异。.
结果: 多因素分析结果显示，患者年龄≤45岁（P =0.039）、强化预处理方案中包含氟达拉滨/克拉屈滨+阿糖胞苷（P =0.002）、移植后d 30白蛋白≤30 g/L（P =0.007）、CMV-DNA+（P =0.028）、移植前有真菌感染（P =0.026）、Ⅱ-Ⅳ度aGVHD的发生（P =0.006）是发生LOHC的独立危险因素；在已发生LOHC的移植患者中，LOHC发生的时间在移植后32 d内（P =0.008）、移植后d 30的白蛋白≤30 g/L（P =0.032）是发展为重度LOHC的独立危险因素。重度LOHC组的OS率显著低于未发生LOHC组（P =0.041）。.
结论: 对于年龄≤45岁、强化预处理或LOHC发生较早的移植患者，需要警惕发生LOHC或发展为重度LOHC，应早期做好防治；定期监测CMV-DNA、白蛋白水平，积极有效地抗病毒、抗真菌治疗及防治aGVHD是预防LOHC发生发展的有效措施。.
Keywords: allogeneic hematopoietic stem cell transplantation; graft-versus-host disease; late-onset hemorrhagic cystitis; risk factors.