Shen Biao, Ma Yueshen, Zhang Haixiao, Wang Mingyang, Liu Jia, Cao Jiaxin, Guo Wenwen, Feng Dan, Yang Donglin, Zhang Rongli, Chen Xin, Ma Qiaoling, Zhai Weihua, Feng Sizhou, Han Mingzhe, Pang Aiming, Jiang Erlie
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College and Chinese Academy, Tianjin, China.
Administration Office of Biostatistics, Center for Information and Resources, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College and Chinese Academy, Tianjin, China.
Blood Sci. 2022 May 17;4(2):83-88. doi: 10.1097/BS9.0000000000000110. eCollection 2022 Apr.
Hemorrhagic cystitis (HC) is a common complication of allogeneic hematopoietic stem cell transplantation (HSCT). The incidence is about 7% to 68%, and some patients have to suffer a long period of frequent, urgent, and painful urination, which brings great pain. This study aimed to analyze risk factors of HC and its effect on patient survival. We collected the medical records of 859 patients who underwent HSCT at our hospital between August 2016 and August 2020. Patients with and without HC were matched using propensity score matching at a 1:1 ratio based on sex, age, and diagnosis, and logistic regression analyses were used to identify factors associated with HC. We used Kaplan-Meier curves to analyze the survival rates of patients in the HC and non-HC groups. We also analyzed the relationship between BK viral load and the occurrence of HC using receiver operating characteristic curve (ROC) analysis. After propensity score matching, there were 131 patients each in the HC and non-HC groups. In the HC group, 89 patients (67.9%) had mild HC (stage II°) and 43 (32.1%) had severe HC (stage III-IV). The median interval between stem cell transplantation and HC development was 31 (3-244) days. Univariate analysis indicated that donor age, hematopoietic stem cell source, HLA, acute graft-versus-host disease, busulfan, anti-thymocyte globulin (ATG), total body irradiation, cytomegalovirus (CMV) (urine), and BK polyomavirus (BKV) (urine) were significantly associated with HC. ATG, CMV (urine), and BKV (urine) were independent risk factors for HC based on the multivariate analysis. The Kaplan-Meier survival analysis showed no significant difference between the HC and non-HC groups ( = .14). The 1- and 2-year survival rates in the HC group were 78.4% and 69.6%, respectively, and the corresponding rates in the non-HC group were 84.4% and 80.7%, respectively. ROC analysis indicated that a urine BKV load of 1 × 10 copies/mL was able to stratify the risk of HC. In conclusion, when the BKV load is >1 × 10, we need to be aware of the potential for the development of HC.
出血性膀胱炎（HC）是异基因造血干细胞移植（HSCT）的常见并发症。其发生率约为7%至68%，一些患者不得不长期忍受尿频、尿急和尿痛，这带来了极大的痛苦。本研究旨在分析HC的危险因素及其对患者生存的影响。我们收集了2016年8月至2020年8月在我院接受HSCT的859例患者的病历。根据性别、年龄和诊断，采用倾向得分匹配法以1:1的比例对有HC和无HC的患者进行匹配，并使用逻辑回归分析来确定与HC相关的因素。我们使用Kaplan-Meier曲线分析HC组和非HC组患者的生存率。我们还使用受试者工作特征曲线（ROC）分析来分析BK病毒载量与HC发生之间的关系。经过倾向得分匹配后，HC组和非HC组各有131例患者。在HC组中，89例患者（67.9%）患有轻度HC（II°期），43例（32.1%）患有重度HC（III-IV期）。干细胞移植与HC发生之间的中位间隔时间为31（3 - 244）天。单因素分析表明，供体年龄、造血干细胞来源、人类白细胞抗原（HLA）、急性移植物抗宿主病、白消安、抗胸腺细胞球蛋白（ATG）、全身照射、巨细胞病毒（CMV）（尿液）和BK多瘤病毒（BKV）（尿液）与HC显著相关。基于多因素分析，ATG、CMV（尿液）和BKV（尿液）是HC的独立危险因素。Kaplan-Meier生存分析显示HC组和非HC组之间无显著差异（=0.14）。HC组的1年和2年生存率分别为78.4%和69.6%，非HC组的相应生存率分别为84.4%和80.7%。ROC分析表明，尿液BKV载量为1×10拷贝/mL能够对HC风险进行分层。总之，当BKV载量>1×10时，我们需要警惕HC发生的可能性。
