Korean J Hematol 2002; 37(2):
Published online June 30, 2002
© The Korean Society of Hematology
동종 조혈모세포이식 후 발생한 출혈성방광염의 위험인자
신호진, 이종욱, 박치영, 박윤희, 김유진, 이석, 민창기, 김희제, 김동욱, 민우성, 김춘추
가톨릭대학교 의과대학 내과학교실, 가톨릭대학교 의과대학 조혈모세포이식센터
Risk Factors of Hemorrhagic Cystitis after Allogeneic Stem Cell Transplantation
Background : Hemorrhagic cystitis (HC) is one of major causes of morbidity during hematopoietic stem cell transplantation (HSCT), occurring in 7∼52% of transplant recipients. We have analyzed the incidence, risk factors, and complications of early (≤4 weeks post- transplant) and late-onset HC (4 weeks∼100 days post-transplant).
Methods : To investigate the risk factors and complications of HC, we retrospectively analyzed 378 patients who underwent allogeneic HSCT in Catholic Hematopoietic Stem Cell Transplantation Center between January 1998 and December 2000. Urine specimens of patients with HC were requested for the detection of virus by polymerase chain reaction (PCR) and culture.
Results : HC occurred in 28 patients with an incidence of 7.4%, and 24 among 28 patients (86%) had severe HC (≥grade Ⅱ) with urinary obstruction and renal failure (n=2). One patient with grade Ⅳ HC died of pneumonia associated with persistent HC. Early and late-onset HC developed at median 9 (2∼20) and 55 (31∼100) days post-transplant, respectively. Median duration of HC was 16 (3∼153) days. Of 23 evaluable patients for study in urine, BK virus was detected in 52% by culture and in
61% by PCR, whereas adenovirus in 18% by PCR. By univariate analysis, disease of aplastic anemia (P=0.03) and non-use of radiation in conditioning regimen (P=0.003) were risk factors for early-onset HC, while the use of busulfan in conditioning regimen(P=0.02) and grade Ⅱ-Ⅳ acute graft-versus-host disease (GVHD) (P=0.00001) for late-onset HC. By multivariate analysis, use of busulfan (RR=16.62, P=0.002) and aplastic anemia than other disease (RR=9.6, P=0.008) were unfavorable factor for early-onset HC, as only grade Ⅱ-Ⅳ acute GVHD (RR=6, P=0.001) for late-onset HC.
Conclusion : More than half of patients with HC developed after allogeneic HSCT were associated with urinary excretion of BK virus. Because of HC is one of the important causes of morbidity after allogeneic HSCT, special attention should be paid to attempting the prevention of HC in patients with high-risk for the development of HC.
Keywords Hemorrhagic cystitis; Allogeneic stem cell transplantation; Risk factors;
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Korean J Hematol 2002; 37(2): 120-126
Published online June 30, 2002
Copyright © The Korean Society of Hematology.
동종 조혈모세포이식 후 발생한 출혈성방광염의 위험인자
신호진, 이종욱, 박치영, 박윤희, 김유진, 이석, 민창기, 김희제, 김동욱, 민우성, 김춘추
가톨릭대학교 의과대학 내과학교실, 가톨릭대학교 의과대학 조혈모세포이식센터
Risk Factors of Hemorrhagic Cystitis after Allogeneic Stem Cell Transplantation
Ho Jin Shin, Jong Wook Lee, Chi Young Park, Yoon Hee Park, Yoo Jin Kim, Seok Lee, Chang Ki Min, Hee Je Kim, Dong Wook Kim, Woo Sung Min, Chun Choo Kim
Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea, Seoul, Korea
Abstract
Background : Hemorrhagic cystitis (HC) is one of major causes of morbidity during hematopoietic stem cell transplantation (HSCT), occurring in 7∼52% of transplant recipients. We have analyzed the incidence, risk factors, and complications of early (≤4 weeks post- transplant) and late-onset HC (4 weeks∼100 days post-transplant).
Methods : To investigate the risk factors and complications of HC, we retrospectively analyzed 378 patients who underwent allogeneic HSCT in Catholic Hematopoietic Stem Cell Transplantation Center between January 1998 and December 2000. Urine specimens of patients with HC were requested for the detection of virus by polymerase chain reaction (PCR) and culture.
Results : HC occurred in 28 patients with an incidence of 7.4%, and 24 among 28 patients (86%) had severe HC (≥grade Ⅱ) with urinary obstruction and renal failure (n=2). One patient with grade Ⅳ HC died of pneumonia associated with persistent HC. Early and late-onset HC developed at median 9 (2∼20) and 55 (31∼100) days post-transplant, respectively. Median duration of HC was 16 (3∼153) days. Of 23 evaluable patients for study in urine, BK virus was detected in 52% by culture and in
61% by PCR, whereas adenovirus in 18% by PCR. By univariate analysis, disease of aplastic anemia (P=0.03) and non-use of radiation in conditioning regimen (P=0.003) were risk factors for early-onset HC, while the use of busulfan in conditioning regimen(P=0.02) and grade Ⅱ-Ⅳ acute graft-versus-host disease (GVHD) (P=0.00001) for late-onset HC. By multivariate analysis, use of busulfan (RR=16.62, P=0.002) and aplastic anemia than other disease (RR=9.6, P=0.008) were unfavorable factor for early-onset HC, as only grade Ⅱ-Ⅳ acute GVHD (RR=6, P=0.001) for late-onset HC.
Conclusion : More than half of patients with HC developed after allogeneic HSCT were associated with urinary excretion of BK virus. Because of HC is one of the important causes of morbidity after allogeneic HSCT, special attention should be paid to attempting the prevention of HC in patients with high-risk for the development of HC.
Keywords: Hemorrhagic cystitis, Allogeneic stem cell transplantation, Risk factors,
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