Arai Yasuyuki, Maeda Takeshi, Sugiura Hiroyuki, Matsui Hiroyuki, Jo Tomoyasu, Ueda Tomoaki, Okada Kazuya, Kawata Takehito, Onishi Tatsuhito, Mizutani Chisato, Ueda Yasunori
Department of Haematology/Oncology, Kurashiki Central Hospital, Okayama, Japan.
Hematology. 2012 Jul;17(4):207-14. doi: 10.1179/1607845412Y.0000000010.
Hemorrhagic cystitis (HC) is a major complication after allogeneic stem cell transplantation (allo-SCT) and can be life threatening. To analyze risk factors and prognosis, we retrospectively reviewed 249 cases receiving allo-SCT in our institution. Median age was 47 years (13-72 years). Disease status at SCT was progressive in 73 cases. Conditioning was myeloablative (MAC) in 146 cases. Acute graft-versus-host disease (aGVHD) grade II-IV treated with prednisolone occurred in 82 cases, and cytomegalovirus (CMV) was reactivated in 91 cases. HC was reported in 47 cases at a median of 35 days (7-469 days) after SCT, and 34 (72.3%) cases recovered after a median of 19.5 days (2-252 days). In univariate analysis, the identified risk factors for HC included age over 45 years, progressive disease status, MAC, aGVHD treated with prednisolone, and CMV reactivation. In multivariate analysis, older age, MAC, and CMV remained independent predictors (hazard ratios: 2.35, 3.50, and 2.87). In patients with severe HC, percentage recovery was lower (3 in 13 cases; 23.1%) and the median duration was longer (54 days) than in those with moderate HC (31 in 36 cases; 86.1%, 17 days, P < 0.01). Treatment-related mortality was also higher (59.1%, P = 0.03) and overall survival was poorer (16.7%, P < 0.01) at 1 year after SCT. Prospective studies should be started considering prophylactic antiviral administration in high-risk patients such as those identified in this study.
出血性膀胱炎（HC）是异基因干细胞移植（allo-SCT）后的一种主要并发症，可能危及生命。为分析危险因素和预后，我们回顾性分析了在我院接受allo-SCT的249例患者。中位年龄为47岁（13 - 72岁）。移植时疾病处于进展期的有73例。146例采用清髓性预处理（MAC）。82例接受泼尼松龙治疗的急性移植物抗宿主病（aGVHD）Ⅱ - Ⅳ级患者，91例巨细胞病毒（CMV）再激活。47例患者在SCT后中位35天（7 - 469天）报告发生HC，其中34例（72.3%）在中位19.5天（2 - 252天）后恢复。单因素分析中，确定的HC危险因素包括年龄超过45岁、疾病进展状态、MAC、接受泼尼松龙治疗的aGVHD以及CMV再激活。多因素分析中，年龄较大、MAC和CMV仍然是独立的预测因素（风险比：2.35、3.50和2.87）。重度HC患者的恢复率较低（13例中有3例；23.1%），中位持续时间较长（54天），而中度HC患者分别为36例中有31例（86.1%）、17天（P < 0.01）。SCT后1年，治疗相关死亡率也较高（59.1%，P = 0.03），总生存率较差（16.7%，P < 0.01）。应开展前瞻性研究，考虑对本研究中确定的高危患者进行预防性抗病毒治疗。
