Hemorrhagic Cystitis (as a complication of bone marrow transplant)

Hemorrhagic cystitis (HC) is a common and sometimes life-threatening complication of hemopoietic cell transplantation (HCT) occurring in 7-52% of transplant recipients and contributing to mortality in 2-4%.1,2 Moreover, severe cystitis has been reported to occur in about 5% of HCT patients.1 These patients develop gross hematuria accompanied by clot formation, severe pain and occasionally uncontrollable bleeding, urinary tract obstruction and renal failure. In this setting, patients are extremely debilitated, require prolonged hospitalization and may finally die.
Early HC is usually a complication of high-dose cyclophosphamide (CY) containing preparative regimens. The routine use of 2-mercaptoethane sulfonate sodium (mesnaR), hydration, and forced diuresis with or without bladder irrigation has largely eliminated early HC.3 In contrast, late HC remains a continuing complication for any HCT and appears to be virally mediated (adenovirus types 11 and 21, polyomavirus BK and JC).4 Other factors including radiation and drugs such as busulfan may also play a role in HC in patients undergoing HCT.

Numerous therapeutic approaches have been tried in HC without success. Since there is no effective therapy, medical management is based on intensive supportive treatment with red-cell and platelet transfusions, bladder irrigation and pain management. The use of bladder instillation of alum, prostaglandin, silver nitrate, phenol or formalin; surgical treatment with cystoscopy, cystotomy or cystectomy; administration of estrogens and hyperbaric oxygen treatment have been tried when previous treatments have failed, but with modest results.5,6,7,8 In patients where a viral etiology has been confirmed, antiviral treatment is indicated. However, there is no clear evidence that specific antiviral treatment resolves HC, although in some cases it can improve clinical symptoms.9