The role of different risk factors in clinical presentation of hemorrhagic cystitis in hematopoietic stem cell transplant recipients.

Various risk factors play roles in hemorrhagic cystitis (HC) presentation and grading in hematopoietic stem cell transplant (HSCT) patients. We retrospectively sought to study these risk factors among the clinical and laboratory records of 283 patients transplanted between 1995 and 2007. Most patients underwent a myeloablative conditioning regimen, but some, a nonmyeloablative regimen. The collected results were analyzed using version 16 of SPSS soft ware. HC was observed in 120 patients (42.4%). The most cases of early onset of HC were detected among donor-recipient gender mismatches (P = .086). Significant correlations were detected between late onset of HC with use of bone marrow as a source of stem cells (P = .001), as well as with class II or III of thalassemia as an underlying disease in HSCT recipients (P = .019). Treatment with cyclophosphamide with busulfan or with antithymocyte globulin (ATG) as the transplant conditioning regimen increased the risk of late-onset HC (P = .001 or P = .073, respectively). A significant relationship was diagnosed between lower grades and late onset of HC with anti-human cytomegalovirus gancyclovir or intravenous immunoglobulin (IVIg) therapy (P = .002). The results of this study showed that significant correlations to the incidence and severity of HC clinical symptoms in HSCT patients among allogeneic transplantations, donor-recipient gender mismatches, bone marrow as a stem cell source, class II and III of thalassemia, use of busulfan plus cyclophosphamide plus ATG in the conditioning regimen, graft-versus-host disease (GVHD) symptoms, use of prednisolone and cyclosporine as prophylaxis treatment of GVHD, and gancyclovir and IVIg as antiviral drugs.