Liang Liuqin, Chen Donging, Wang Xiaodong, Yang Zheng, Zhou Jun, Zhan Zhongping, Lian Fan
Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Sun Yat-Sen University, No. 58, Zhongshan 2nd Road, Guangzhou, 510080, China.
Department of Ultrasound, The First Affiliated Hospital of Chinese Traditional Medical University, No. 16, Airport Road, Guangzhou, 510405, China.
Drugs Real World Outcomes. 2017 Sep;4(3):175-182. doi: 10.1007/s40801-017-0112-y.
The aim of this study was to investigate the prevalence, severity, risk factors, and treatment outcomes of cyclophosphamide (CYC)-induced hemorrhagic cystitis (HC) in patients with rheumatic diseases.
We collected the clinical data from 1284 consecutive patients admitted to The First Affiliated Hospital of Sun Yat-Sen University who were treated with CYC between 2006 and 2016, and then conducted a retrospective analysis.
The mean cumulative dose of CYC was 18.3 ± 13.4 g, and the mean treatment duration of CYC was 10.0 ± 7.2 months. We identified four patients with HC, yielding a crude prevalence of 0.3%. The average time from initial primary diagnosis to HC onset was 51.6 months (33-86 months). All of the four patients with HC were exposed to a high cumulative CYC dose (>60 g). Severity was assessed as grade II in one, grade III in one and grade IV in two patients. One had resolution of hematuria after hydration, and one case resolved after combination therapy of clot removal by cystoscopy, hydration, and bladder irrigation. The other two were unresponsive to the above treatment and finally had resolution after cystectomy. The average resolution time of hematuria was 39.5 days (7-56 days). There were no deaths in our cohort.
CYC-induced HC was rare and highly variable in Chinese patients with rheumatic diseases. Individualized treatment should be performed according to the severity of HC for each patient. More aggressive treatment strategies might improve the outcomes of patients with high-grade HC (grades III and IV). Our findings strengthened the link between HC events and higher cumulative CYC exposure (>60 g).
本研究旨在调查环磷酰胺（CYC）诱发的出血性膀胱炎（HC）在风湿性疾病患者中的患病率、严重程度、危险因素及治疗结果。
我们收集了2006年至2016年间在中山大学附属第一医院连续收治的1284例接受CYC治疗的患者的临床资料，然后进行回顾性分析。
CYC的平均累积剂量为18.3±13.4g，CYC的平均治疗持续时间为10.0±7.2个月。我们确定了4例HC患者，粗患病率为0.3%。从最初的原发性诊断到HC发作的平均时间为51.6个月（33 - 86个月）。所有4例HC患者均暴露于高累积CYC剂量（>60g）。严重程度评估为1例II级、1例III级和2例IV级。1例经水化治疗后血尿消退，1例经膀胱镜下血块清除、水化及膀胱冲洗联合治疗后缓解。另外2例对上述治疗无反应，最终膀胱切除术后缓解。血尿的平均消退时间为39.5天（7 - 56天）。我们的队列中无死亡病例。
CYC诱发的HC在中国风湿性疾病患者中罕见且差异很大。应根据每位患者HC的严重程度进行个体化治疗。更积极的治疗策略可能改善高级别HC（III级和IV级）患者的治疗结果。我们的研究结果强化了HC事件与更高累积CYC暴露（>60g）之间的联系。
