Allojeneik kemik iliği nakil hastalarında post-transplant dönemde hemorajik sistit vakalarının dağılımı ve tedavi şeklinin retrospektif değerlendirilmesi
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Date
2020
Authors
Anaç, İsmail
Journal Title
Journal ISSN
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Hemorajik sistit genellikle allojeneik hematopoetik kök hücre naklinden sonra ortaya çıkar. Hematopoetik kök hücre nakli hastalarında önemli bir morbidite ve nadiren mortalite nedenidir. Allojeneik hematopoetik kök hücre transplantasyonu yapılan hematolojik maligniteli hastalar retrospektif olarak incelenerek hemorajik sistit sıklığı, risk faktörleri, verilen tedaviler, tedaviye yanıt oranları ve hastalıksız sağkalım üzerine etkisinin saptanması amaçlanmıştır. Bursa Uludağ Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalı, Hematoloji Bilim Dalı Kök Hücre Transplantasyon Ünitesi’nde 2011 ile 2019 yılları arasında allojeneik hematopoetik kök hücre transplantasyonu yapılmış hematolojik maligniteli 110 hasta retrospektif olarak incelenmiştir. Hemorajik sistit 110 hastanın 34’ünde (%30.9) gelişti. Hemorajik sistit gelişen hastaların 14’ünde (%41.2) erken dönem hemorajik sistit, 20’sinde (%58.8) geç dönem hemorajik sistit saptandı. Ortalama hemorajik sistit gelişme zamanı 32.50 (-2-226) gündü. Hastaların 24’ünde (%70.6) yönetilebilir (grade 1 veya 2) toksisite, 10’unda (%29.4) ciddi (grade 3 veya 4) toksisite gelişmişti. Risk faktörleri açısından yapılan tek değişkenli analizde transplant yaşı, cinsiyet, akut graft versus host hastalığı, uygulanan nakil rejimi, donör-alıcı cinsiyet uyumluluğu, sitomegalovirüs geçirme öyküsü, steroid kullanımı, primer hastalık değerlendirildi. Hiçbiri anlamlı risk faktörü olarak saptanmadı. Hemorajik sistit geçiren tüm hastalara intravenöz hidrasyon tedavisi verildi. Hastaların 9’una (%26.5) mesane içi foley sonda ile irrigasyon uygulandı. BKV saptanan 10 hastanın 8’ine cidofovir tedavisi verildi. CMV saptanan 8 hastaya valgansiklovir veya gansiklovir tedavisi verildi. Grade 4 hemorajik sistit gelişen 4 hastada hematüri ancak sistoskopik olarak mesaneden koagülum boşaltımı ve koteterizasyon yapılarak durdurulabildi. Hastalara ortalama 28 gün (3-190 gün) tedavi verildi. Hastaların 2’sinde (%5.9) tedavilere cevap alınamadı. Mortalite üzerine yapılan değerlendirmede hemorajik sistit varlığının genel sağ kalım süresi üzerinde bir risk faktörü olduğu belirlenirken hemorajik sistit gözlenmesi durumunda mortalite riskinin hemorajik sistit gözlenmemesi durumuna göre 1.82 kat daha fazla olduğu belirlenmiştir. Sonuç olarak allojeneik hematopoetik nakil hastalarında gelişen hemorajik sistitin mortalite riskini artırdığı saptanmıştır. Bu nedenle mortaliteyi azaltmak için hemorajik sistitin nedenlerinin belirlenmesi ve standart bir tedavi protokolünün oluşturulması gerekmektedir. Bunun için prospektif büyük ölçekli çalışmalara ihtiyaç vardır.
Hemorrhagic cystitis frequently occurs after allogeneic hematologic stem cell transplantation. For allogeneic hematologic stem cell transplantation patients, it is an important cause of morbidity and rarely mortality. We aimed to determine prevelance, risk factors, treatments given, treatment response rates and effects of disease free survival of hemorrhagic cystitis by retrospectively analyzing our patients with hematological malignancy who underwent allogeneic hematopoietic stem cell transplantation. We were retrospectively examined 110 patients with hematological malignancy who underwent allogeneic hematopoietic stem cell transplantation in the Bursa Uludag Univercity Faculty of Medicine Internal Medicine Department, Hematology Department Stem Cell Transplantation Unit between 2011 and 2019. Hemorrhagic cystitis developed in 34 (30.9%) of 110 patients. Among these patients 14 was detected early hemorrhagic cystitis (41.2%) and 20 was detected late hemorrhagic cystitis (58.8%). The mean time to hemorrhagic cystitis development was 32.5 days (-2-226). There is manageable toxicity (grade 1 or 2) in 24 patients (70.6%) and severe toxicity (grade 3 or 4) in 10 (29.4%) patients. In univariate analysis, transplant age, gender, acute gvhd, transplant regimen, donor recipient gender compatibility, CMV history, steroid usage and primary disease was evaluated for risk factors. None of them were detected as significant risk factors. Patients with hemorrhagic cystitis were administered intravenous hydration therapy. Irrigation with intrabladder foley catheter was performed in 9 patients (26.5%). Cidofovir treatment was used for 8 of 10 patients with BK virüs. Valgancyclovir of gancyclovir treatment was used for 8 patients with CMV. Advanced urological procedures suc as coagulum emptying and co-etherization from bladder was needed for 4 patients with class 4 hemorrhagic cystitis. Patients with hemorrhagic cystitis were treated for and average of 28 days (3-190). Treatment response was not obtained in 2 patients (5.9%). While hemorrhagic cystitis development was found as a risk factor for overall survival in mortality analysis, mortality risk was 1.82 fold higher in patients with hemorrhagic cystitis than patients that not developed hemorrhagic cystitis. In conclusion, it increased the mortality risk of hemorrhagic cystitis development in allogeneic hematopoietic transplant recipient. In order to minimize the mortality, it requires to identify of the causes of hemorrhagic cystitis and constitute a standart treatment protocol. Prospective studies with large samples was needed to obtaining these achievements.
Hemorrhagic cystitis frequently occurs after allogeneic hematologic stem cell transplantation. For allogeneic hematologic stem cell transplantation patients, it is an important cause of morbidity and rarely mortality. We aimed to determine prevelance, risk factors, treatments given, treatment response rates and effects of disease free survival of hemorrhagic cystitis by retrospectively analyzing our patients with hematological malignancy who underwent allogeneic hematopoietic stem cell transplantation. We were retrospectively examined 110 patients with hematological malignancy who underwent allogeneic hematopoietic stem cell transplantation in the Bursa Uludag Univercity Faculty of Medicine Internal Medicine Department, Hematology Department Stem Cell Transplantation Unit between 2011 and 2019. Hemorrhagic cystitis developed in 34 (30.9%) of 110 patients. Among these patients 14 was detected early hemorrhagic cystitis (41.2%) and 20 was detected late hemorrhagic cystitis (58.8%). The mean time to hemorrhagic cystitis development was 32.5 days (-2-226). There is manageable toxicity (grade 1 or 2) in 24 patients (70.6%) and severe toxicity (grade 3 or 4) in 10 (29.4%) patients. In univariate analysis, transplant age, gender, acute gvhd, transplant regimen, donor recipient gender compatibility, CMV history, steroid usage and primary disease was evaluated for risk factors. None of them were detected as significant risk factors. Patients with hemorrhagic cystitis were administered intravenous hydration therapy. Irrigation with intrabladder foley catheter was performed in 9 patients (26.5%). Cidofovir treatment was used for 8 of 10 patients with BK virüs. Valgancyclovir of gancyclovir treatment was used for 8 patients with CMV. Advanced urological procedures suc as coagulum emptying and co-etherization from bladder was needed for 4 patients with class 4 hemorrhagic cystitis. Patients with hemorrhagic cystitis were treated for and average of 28 days (3-190). Treatment response was not obtained in 2 patients (5.9%). While hemorrhagic cystitis development was found as a risk factor for overall survival in mortality analysis, mortality risk was 1.82 fold higher in patients with hemorrhagic cystitis than patients that not developed hemorrhagic cystitis. In conclusion, it increased the mortality risk of hemorrhagic cystitis development in allogeneic hematopoietic transplant recipient. In order to minimize the mortality, it requires to identify of the causes of hemorrhagic cystitis and constitute a standart treatment protocol. Prospective studies with large samples was needed to obtaining these achievements.
Description
Keywords
Allojeneik kök hücre transplantasyonu, Hemorajik sistit, BK virüs, Allogeneic stem cell transplantation, Hemorrhagic cystitis
Citation
Anaç, İ. (2020). Allojeneik kemik iliği nakil hastalarında post-transplant dönemde hemorajik sistit vakalarının dağılımı ve tedavi şeklinin retrospektif değerlendirilmesi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.