Saito Yoshimasa, Kumamoto Tadashi, Shiraiwa Miki, Sonoda Tomoko, Arakawa Ayumu, Hashimoto Hironobu, Tamai Ikumi, Ogawa Chitose, Terakado Hiroyuki
Department of Pharmacy, National Cancer Center Hospital, Tokyo, Japan.
Faculty of Pharmaceutical Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.
Asia Pac J Clin Oncol. 2018 Oct;14(5):e460-e464. doi: 10.1111/ajco.13048. Epub 2018 Jul 10.
Although hemorrhagic cystitis (HC) is a significant complication in young patients who undergo chemotherapy with cyclophosphamide (CPA), risk factors and supportive care to prevent HC are unclear. This study attempted to identify optimal supportive care to prevent CPA-induced HC.
Patients (< 30-year-old) with malignant solid tumors who had been treated with CPA-containing chemotherapy in inpatient treatment were eligible. Vigorous hydration to increase urine output and intravenous 2-mercaptethane sulfonate (mesna) were used for prophylaxis of CPA-induced HC. We retrospectively analyzed 81 patients who had been treated with CPA-containing chemotherapy over (collectively) 486 cycles, and examined relationships between HC and various factors, especially CPA dosage, use of mesna, and fluid infusion volume/rate.
HC occurred in four patients (4.9%) and five cycles (1%). When stratifying by doses and methods of administration of CPA, HC occurred in 3/323 low- and intermediate-dose (< 1500 mg/m /day) cycles and mesna was used in all three cycles with HC. Patients who were given mesna had a lower flow rate than those given hydration alone in the low- and intermediate-dose CPA (126 ± 25 vs 106 ± 16 mL/m /h; P < 0.01). All patients who received high-dose CPA (≥1500 mg/m /day) were also given mesna and vigorous hydration (115 ± 16 mL/m /h).
Our supportive care measures may be effective in preventing CPA-induced HC. Patients who receive CPA doses < 1500 mg/m /day should get ≥125 mL/m /h of infused fluid, regardless of mesna usage; those who receive of CPA ≥1500 mg/m /day should also receive mesna and vigorous hydration.
尽管出血性膀胱炎（HC）是接受环磷酰胺（CPA）化疗的年轻患者的一种重要并发症，但预防HC的危险因素和支持性治疗尚不清楚。本研究试图确定预防CPA诱导的HC的最佳支持性治疗方法。
年龄小于30岁、在住院治疗中接受含CPA化疗的恶性实体瘤患者符合条件。采用积极补液以增加尿量和静脉注射2-巯基乙烷磺酸钠（美司钠）来预防CPA诱导的HC。我们回顾性分析了81例接受含CPA化疗（共486个周期）的患者，并研究了HC与各种因素之间的关系，特别是CPA剂量、美司钠的使用以及液体输注量/速率。
4例患者（4.9%）和5个周期（1%）发生了HC。按CPA的剂量和给药方法分层时，3/323个低剂量和中等剂量（<1500mg/m²/天）周期发生了HC，所有3个发生HC的周期都使用了美司钠。在低剂量和中等剂量CPA治疗中，接受美司钠治疗的患者的流速低于仅接受补液治疗的患者（126±25 vs 106±16mL/m²/h；P<0.01）。所有接受高剂量CPA（≥1500mg/m²/天）的患者也接受了美司钠和积极补液（115±16mL/m²/h）。
我们的支持性治疗措施可能对预防CPA诱导的HC有效。接受CPA剂量<1500mg/m²/天的患者，无论是否使用美司钠，应接受≥125mL/m²/h的输注液体；接受CPA≥1500mg/m²/天的患者也应接受美司钠和积极补液。
