Risk factors for late-onset hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation: analysis of 227 cases

Abstract

Objective To analyze the risk factors of late-onset hemorrhagic cystitis (LOHC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods We retrospectively analyzed 227 patients who underwent allo-HSCT in our hospital from 2016 to 2020. Univariate and multivariate analyses were performed in 215 patients with hematopoietic reconstitution for the clinical factors related to LOHC, and survival analysis and subgroup analysis were also carried out. Results LOHC occurred in 72 (31.7%) patients at a median 31 (8~80) d after allo-HSCT, for a median duration of 24 (3~100) d. The results of univariate and multivariate analyses indicated that gender incompatibility in donors and recipients, intensified conditioning regimen with fludarabine/cladribine and cytarabine, cytomegalovirus (CMV)-DNA positive and acute graft-versus-host disease (aGVHD) significantly increased the incidence of LOHC (P=0.025, < 0.001, 0.021 and 0.028, respectively). The LOHC patients had a lower overall survival (OS) rate than those without (P=0.035), moreover, those with aGVHD simultaneously had worse OS rate than those without (P=0.005). Subgroup analysis of acute leukemia (AL) showed that patients in first complete remission (CR1) before allo-HSCT had a lower incidence of LOHC than others (OR=2.964, 95%CI: 1.255~7.003, P=0.013). Conclusion Gender incompatibility in donors and recipients, intensified conditioning regimen (including FA/CA), CMV-DNA positive and aGVHD are independent risk factors for LOHC.

Keywords

• allogeneic hematopoietic stem cell transplantation
• late-onset hemorrhagic cystitis
• risk factors