Hemorrhagic cystitis following hematopoietic stem cell transplantation: incidence, risk factors and association with CMV reactivation and graft-versus-host disease / 中华医学杂志(英文版)
Chinese Medical Journal
; (24): 1666-1671, 2007.
Article
em En
| WPRIM
| ID: wpr-280365
Biblioteca responsável:
WPRO
ABSTRACT
<p><b>BACKGROUND</b>The definite pathogenesis of hemorrhagic cystitis (HC) after allogenic hematopoietic stem cell transplantation (allo-HSCT) has not been well elucidated. The role of cytomegalovirus (CMV) reactivation and graft-versus-host disease (GVHD) in the development of HC remains obscure. This study determined the incidence and risk factors for HC after allo-HSCT and analyzed its association with CMV reactivation and GVHD.</p><p><b>METHODS</b>We retrospectively studied 250 patients at high risk for CMV disease who underwent allo-HSCT all based on busulfan/cyclophosphamide (BU/CY) myloablative regimens. The incidence, etiology, risk factors and clinical management of HC were investigated.</p><p><b>RESULTS</b>HC developed within 180 days of transplant in 72 patients, with an overall incidence of 28.8% and an incidence of 12.6% in patients with HLA-matched related donors (MRD), 34.38% in those with HLA-matched unrelated donors (MUD), 49.45% in those with mismatched related donors (MMRD). CMV-viremia significantly increased the incidence of later onset HC (LOHC); however, only 9 out of 15 patients with CMV viruria actually developed LOHC. Multiple regression analysis identified grade II - IV acute GVHD (RR = 2.75; 95% CI 1.63 +/- 4.66; P < 0.01) and grafts from MUD or MMRD (RR = 2.60; 95% CI 1.52 +/- 5.20; P < 0.01) as independent risk factors for HC. Event sequence analysis indicated a majority of HC episodes began around GVHD initiation.</p><p><b>CONCLUSIONS</b>CMV-viremia is a high risk factor for LOHC. Our data also showed a correlation between acute GVHD and HC, which suggested that alloimmunity may be involved in the pathogenesis of HC.</p>
Texto completo:
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Base de dados:
WPRIM
Assunto principal:
Viremia
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Ativação Viral
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Epidemiologia
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Incidência
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Análise Multivariada
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Estudos Retrospectivos
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Fatores de Risco
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Infecções por Citomegalovirus
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Transplante de Células-Tronco Hematopoéticas
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Cistite
Tipo de estudo:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Humans
Idioma:
En
Revista:
Chinese Medical Journal
Ano de publicação:
2007
Tipo de documento:
Article