A survey on the practices and the management of hemorrhagic cystitis in patients who undergo allogeneic hematopoietic stem cell transplantation, on behalf of the Infectious Diseases Working Party of EBMT

Abstract

This survey reports on the current practice and management of hemorrhagic cystitis (HC) among the EBMT centers. The survey response rate was 27%. The diagnostic search of BK polyomavirus (BKPyV) was available in 93% of centers and performed in urine (100%), blood/plasma (51%), and serum (12%). Patient screening for BKPyV infection was performed in 14% of centers before hematopoietic cell transplantation (HCT). In comparison, surveillance for BKPyV infection was performed after HCT in 39% of centers, mainly with a frequency of 1-2 times/week. Preventative measures are based mainly on hyperhydration and sodium 2-mercaptoethanesulphonate (Mesna), while the use of bladder catheter is limited; moreover, 23% of centers used quinolones prophylaxis.The primary therapeutic interventions are hyperhydration, Mesna, analgesics, and sustained platelet transfusions; bladder irrigation by urinary catheter is adopted by 47-50% of centers. In the case of BKPyV infection, 85% of centers use intravenous or intrabladder administration of cidofovir at a dosage ranging from 1 to 5 mg/kg. Centers report a miscellaneous range of alternative therapeutic measures (adoptive immunotherapy, hyperbaric oxygen therapy, fibrin glue/platelet-rich plasma, leflunomide, sodium hyaluronate) and the need for invasive procedures. This survey confirms that the management of HC needs further education, clinical research, and innovation.