Hassan Zuzana, Remberger Mats, Svenberg Petter, Elbander Maria, Omazic Brigitta, Mattsson Jonas, Conrad Réka, Svahn Britt-Marie, Ahlgren Anders, Sairafi Darius, Aschan Johan, Le Blanc Katarina, Barkholt Lisbeth, Ringdén Olle
Center for Allogenic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Clin Transplant. 2007 Sep-Oct;21(5):659-67. doi: 10.1111/j.1399-0012.2007.00705.x.
Severe hemorrhagic cystitis (HC) may be a life-threatening complication in allogeneic stem cell transplantation (SCT). In order to improve the strategies for prophylaxis and treatment, we retrospectively analyzed data on patients who underwent SCT at our center from 1990 through 2005. Patients with HC were identified through our database and their medical charts were reviewed. Grades 2-5 and 3-5 HC developed in 109/834 patients (13.1%) and 27/834 patients (3.2%), respectively. The frequency of HC decreased over the time from 18.0% in 1990-1992 to 9.5% in 2002-2005 (p = 0.005). HC started on a median of 35 (0-166) days post-transplant and persisted for a median of 23 (2-270) days. Transplant-related mortality was 21% in patients without HC, 15% in those with HC of grade 2, 55% in those with grade 3, and 71% in patients with HC of grades 4-5 (p < 0.001). In multivariate analysis, the risk factors for HC were myeloablative conditioning, busulphan, cytomegalovirus infection, hematological malignancy, and acute graft-versus-host disease (aGVHD). With four risk factors, the risk of HC development was 31%. Risk factors for severe HC of grades 3-5 were aGVHD and bacteremia.
严重出血性膀胱炎（HC）可能是异基因干细胞移植（SCT）中一种危及生命的并发症。为了改进预防和治疗策略，我们回顾性分析了1990年至2005年在本中心接受SCT的患者的数据。通过我们的数据库识别出患有HC的患者，并对他们的病历进行了审查。2 - 5级和3 - 5级HC分别在109/834例患者（13.1%）和27/834例患者（3.2%）中发生。HC的发生率随时间下降，从1990 - 1992年的18.0%降至2002 - 2005年的9.5%（p = 0.005）。HC在移植后中位35（0 - 166）天开始，持续中位23（2 - 270）天。无HC患者的移植相关死亡率为21%，2级HC患者为15%，3级患者为55%，4 - 5级HC患者为71%（p < 0.001）。在多变量分析中，HC的危险因素是清髓性预处理、白消安、巨细胞病毒感染、血液系统恶性肿瘤和急性移植物抗宿主病（aGVHD）。有四个危险因素时，发生HC的风险为31%。3 - 5级严重HC的危险因素是aGVHD和菌血症。
