Abstract：
This study investigates the incidence and predictors of hemorrhagic cystitis (HC) in 960 adults undergoing allo- hematopoietic stem cell transplantation. Two hundred fifty-two (26.5%) patients received myeloablative conditioning regimens, and 81.4% received high-dose intravenous busulfan (HD Bu). Six hundred ninety-five (72.4%) patients received post-transplantation cyclophosphamide (PTCY)-based prophylaxis, and 91.4% additionally received anti-thymocyte globulin (ATG) and Cyclosporine A (CsA) (PTCY-ATG-CsA). Two hundred twenty-eight (23.8%) patients developed HC. The day 100 cumulative incidences of grades 2-4 and 3-4 HC were 11.1% and 4.9%. BK virus was isolated in 58.3% of urinary samples. Using HD BU myeloablative regimens increased the risk for grade 2-4 HC (hazard ratio [HR] = 1.97, P = .035), and HD BU combined with ATG-PTCY-CsA increased this 4 times (HR = 4.06, P < .001) for grade 2-4 HC compared to patients who received neither of these drugs. A significant correlation was documented between grade II-IV acute graft-versus-host disease and grade 2-4 HC (HR = 2.10, P < .001). Moreover, patients with BK-POS grade 2-4 HC had lower 1-year overall survival (HR = 1.51, P = .009) and higher non-relapse mortality (HR = 2.31, P < .001), and patients with BK-NEG grade 2-4 HC had comparable post-transplantation outcomes. In conclusion, intravenous HD Bu was identified as a predictor for grade 2-4 HC. Moreover, when HD Bu was combined with PTCY-ATG-CsA, the risk increased 4-fold. Based on the results provided by this study, preventing the onset of HC, especially in high-risk patients, is mandatory because its presence significantly increases the risk for mortality.
摘要：
本研究调查了960名接受allo-HSCT的成年人出血性膀胱炎（HC）的发生率和预测因素。两百五十二（26.5％）患者接受MAC治疗，81.4%接受大剂量静脉注射白消安(HDBu)。六百九十五（72.4％）患者接受了基于PTCY的预防，91.4%额外接受了ATG和CsA(PTCY-ATG-CsA)。228例（23.8%）患者发生HC。第+100天2-4级和3-4级HC的累积发病率分别为11.1%和4.9%。在58.3%的尿液样本中分离出BK病毒。使用HDBU清髓性方案增加2-4级HC的风险（HR1.97，P=0.035），对于2-4级HC，HDBU联合ATG-PTCY-CsA与未接受这些药物的患者相比增加了四倍（HR4.06，HR<0.001）。II-IV级aGVHD和2-4级HC之间存在显著相关性(HR2.10,P<0.001)。此外，BK-POS2-4级HC患者的1年OS较低（HR1.51，P=0.009），NRM较高（HR2.31，P<0.001），BK-NEG2-4级HC患者的移植后结局相当.总之,静脉注射HDBu被确定为2-4级HC的预测因子.此外，当HDBu与PTCY-ATG-CsA联合使用时，风险增加了四倍。根据本研究提供的结果，预防HC的发作，尤其是高危患者，是强制性的，因为它的存在会显著增加死亡风险。
