{"title":"Hemorrhagic Cystitis Following Hematopoietic Stem Cell Transplantation in Children: A Single Pediatric Center Experience.","authors":"Pauline Mazilier, Laurence Dedeken, Eleonore Powis, Pierluigi Calò, Stéphane Luyckx, Kornreich Laure, Diallo Safiatou, Adriano Salaroli, Christine Devalck","doi":"10.1002/pbc.32071","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hemorrhagic cystitis (HC) is a frequent and potentially severe complication following hematopoietic stem cell transplantation (HSCT) in children. It significantly affects the quality of life and prolongs hospitalization. Despite its frequency, no standardized management guidelines exist. This study aimed to describe the characteristics, risk factors, and treatments of HC in a pediatric HSCT population.</p><p><strong>Methods: </strong>We conducted a retrospective single-center study including all pediatric patients who underwent allogeneic HSCT between January 2007 and December 2022. HC was defined and graded according to the European Conference on Infections in Leukaemia (ECIL) guidelines. We analyzed risk factors, BK virus (BKV) viruria, treatments, and outcomes.</p><p><strong>Results: </strong>HC occurred in 24 patients (14.7%), with a median onset at 27.5 days post-HSCT. Acute graft-versus-host disease (aGVHD) was significantly associated with HC occurrence (45.8% vs. 19.4%, p = 0.01), particularly in its severe forms (p = 0.007). BKV was detected in 66.7% of HC cases. Viral load in urine was not significantly associated with HC severity or duration. All patients received supportive care; cidofovir was used in 79.2%, with increasing frequency in higher grade HC. Severe cases required multimodal management, including intravesical installations, hyperbaric oxygen therapy (HBO; 37.5%), and arterial embolization (all Grade 4 cases). No deaths were directly attributed to HC.</p><p><strong>Conclusions: </strong>HC remains a significant and morbid complication after pediatric HSCT. Our findings highlight the need for early identification of high-risk patients and access to timely, multidisciplinary interventions. Multicenter prospective studies are essential to standardize care and improve outcomes in this vulnerable population.</p>","PeriodicalId":19822,"journal":{"name":"Pediatric Blood & Cancer","volume":" ","pages":"e32071"},"PeriodicalIF":2.3000,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Blood & Cancer","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/pbc.32071","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEMATOLOGY","Score":null,"Total":0}
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Abstract
Background: Hemorrhagic cystitis (HC) is a frequent and potentially severe complication following hematopoietic stem cell transplantation (HSCT) in children. It significantly affects the quality of life and prolongs hospitalization. Despite its frequency, no standardized management guidelines exist. This study aimed to describe the characteristics, risk factors, and treatments of HC in a pediatric HSCT population.
Methods: We conducted a retrospective single-center study including all pediatric patients who underwent allogeneic HSCT between January 2007 and December 2022. HC was defined and graded according to the European Conference on Infections in Leukaemia (ECIL) guidelines. We analyzed risk factors, BK virus (BKV) viruria, treatments, and outcomes.
Results: HC occurred in 24 patients (14.7%), with a median onset at 27.5 days post-HSCT. Acute graft-versus-host disease (aGVHD) was significantly associated with HC occurrence (45.8% vs. 19.4%, p = 0.01), particularly in its severe forms (p = 0.007). BKV was detected in 66.7% of HC cases. Viral load in urine was not significantly associated with HC severity or duration. All patients received supportive care; cidofovir was used in 79.2%, with increasing frequency in higher grade HC. Severe cases required multimodal management, including intravesical installations, hyperbaric oxygen therapy (HBO; 37.5%), and arterial embolization (all Grade 4 cases). No deaths were directly attributed to HC.
Conclusions: HC remains a significant and morbid complication after pediatric HSCT. Our findings highlight the need for early identification of high-risk patients and access to timely, multidisciplinary interventions. Multicenter prospective studies are essential to standardize care and improve outcomes in this vulnerable population.
背景：出血性膀胱炎（HC）是儿童造血干细胞移植（HSCT）后常见且可能严重的并发症。它显著影响生活质量并延长住院时间。尽管它的频率很高，但没有标准化的管理指导方针。本研究旨在描述儿童HSCT人群中HC的特征、危险因素和治疗。方法：我们进行了一项回顾性单中心研究，包括2007年1月至2022年12月期间接受同种异体造血干细胞移植的所有儿科患者。HC是根据欧洲白血病感染会议（ECIL）指南定义和分级的。我们分析了危险因素、BKV病毒（BKV）病毒、治疗和结果。结果：24例（14.7%）患者发生HC，中位发病时间为hsct后27.5天。急性移植物抗宿主病（aGVHD）与HC的发生显著相关（45.8% vs. 19.4%, p = 0.01），特别是在其严重形式（p = 0.007）。66.7%的HC检出BKV。尿中病毒载量与丙型肝炎严重程度或病程无显著相关性。所有患者均接受支持性治疗；使用西多福韦的占79.2%，在高等级HC中使用频率增加。严重病例需要多模式管理，包括膀胱内安装、高压氧治疗（HBO; 37.5%）和动脉栓塞（所有4级病例）。没有直接归因于丙型肝炎的死亡。结论：HC仍然是儿童HSCT后一个重要且病态的并发症。我们的研究结果强调了早期识别高风险患者和及时获得多学科干预的必要性。多中心前瞻性研究对于标准化护理和改善这一弱势群体的预后至关重要。
期刊介绍：
Pediatric Blood & Cancer publishes the highest quality manuscripts describing basic and clinical investigations of blood disorders and malignant diseases of childhood including diagnosis, treatment, epidemiology, etiology, biology, and molecular and clinical genetics of these diseases as they affect children, adolescents, and young adults. Pediatric Blood & Cancer will also include studies on such treatment options as hematopoietic stem cell transplantation, immunology, and gene therapy.
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