Background: Radiotherapy is one of the most popular treatments for pelvic malignancy, which causes patients suffering from the adverse effect such as cystitis, hematuria, proctitis, hematochezia and distal ureteric st...Background: Radiotherapy is one of the most popular treatments for pelvic malignancy, which causes patients suffering from the adverse effect such as cystitis, hematuria, proctitis, hematochezia and distal ureteric stricture. The hematuria condition from radiation-induced hemorrhagic cystitis is the most common adverse event suffering the patients, losing properties, wasting time, and deteriorating quality of life. One of the most effective treatments for radiation-induced hemorrhagic cystitis is the hyperbaric oxygen therapy with no necessity for patients to be hospitalized, no need of anesthesia use, and also non-invasion. However, it requires that patients spend 90 - 120 minutes a day for 40 days administered out-patient treatment session. The transportation cost as well as the accommodation one will greatly burden the self-pay health care patients. In addition, there is still no definite standardized number of HBOT treatment session assignment at present. Objectives: To compare the treatment outcome (bladder mucosal characteristics, red blood cells in urine) between 30 and 40 sessions of HBOT for treatment of radiation-induced hemorrhagic cystitis. Methods: Prospective cohort observational study of patients (n = 15) who were diagnosed with radiation-induced hemorrhagic cystitis that were treated with hyperbaric oxygen therapy in Somdechprapinklao Hospital between October 2020 and September 2021. We compared the parameter about hemoglobin concentration, red blood cell number in urine during the course of HBOT treatment every 10 sessions and cystoscopic finding severity as EORTC/RTOG classification for radiation-induced hemorrhagic cystitis in Table 1 before treatment, and after 30 and 40 sessions of treatment. Results: From 15 of treated patients, 93.3% of patients had evidence of posterior wall lesion. The mean duration from radiotherapy (radiation and brachytherapy) to the first episode gross hematuria is 112 months. This study shows no statistically different cystoscopic findings as EORTC/RTOG classification for radiation-induced hemorrhagic cystitis after 30 and 40 sessions of HBOT (p = 0.653) and statistically significant improvement after the treatment of more than 30 sessions (p = 0.008). No relationship was found with the hemoglobin concentration and red blood cell number in urine during the course of HBOT. Conclusions: Radiation-induced hemorrhagic cystitis can be treated with HBOT. There is no different treatment outcome between 30 and 40 sessions of HBOT.展开更多
BACKGROUND The advanced first-line regimen for advanced gastric cancer is based on a combination of fluoropyrimidine and platinum and/or paclitaxel(PTX),forming a two-or three-drug regimen.Compared to conventional PTX...BACKGROUND The advanced first-line regimen for advanced gastric cancer is based on a combination of fluoropyrimidine and platinum and/or paclitaxel(PTX),forming a two-or three-drug regimen.Compared to conventional PTX,nanoparticle albumin-bound PTX(Nab-PTX)has better therapeutic effects and fewer adverse effects reported in studies.Nab-PTX is a great option for patients presenting with advanced gastric cancer.Herein,we highlight an adverse event(hemorrhagic cystitis)of Nab-PTX in advanced gastric cancer.CASE SUMMARY A 55-year-old male was diagnosed with lymph node metastasis after a laparo-scopic-assisted radical gastrectomy for gastric cancer that was treated by Nab-PTX and S-1(AS).On the 15th day after treatment with AS,he was diagnosed with hemorrhagic cystitis.CONCLUSION Physicians should be aware that hemorrhagic cystitis is a potential adverse event associated with Nab-PTX treatment.展开更多
Objective To investigate the efficacy and safety of the optimal alkalized hydration solution for hemorrhagic cystitis ( HC) following unrelated donor allogeneic hem-
Background 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 ...Background 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 alIo-HSCT and analyzed its association with CMV reactivation and GVHD. Methods We retrospectively studied 250 patients at high risk for CMV disease who underwent alIo-HSCT all based on busulfan/cyclophosphamide （BU/CY） myloablative regimens. The incidence, etiology, risk factors and clinical management of HC were investigated. Results 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. Conclusions 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.展开更多
Background The pathophysiology of late-onset hemorrhagic cystitis （LOHC） is currently not well understood. The aim of this study was to analyze the alloimmune aetiology in the pathogenesis of LOHC post allogeneic he...Background The pathophysiology of late-onset hemorrhagic cystitis （LOHC） is currently not well understood. The aim of this study was to analyze the alloimmune aetiology in the pathogenesis of LOHC post allogeneic hematopoietic stem cell transplantation （HSCT）. Methods A retrospective study was performed on the medical records of 11 patients with immune-related LOHC post allogeneic HSCT. The clinical characteristics, therapy, and outcomes of these patients were analyzed. Results The median time of onset was 42 days after HSCT （range 16-150 days） and the median duration of HC was 43 days （range 29-47 days）. All patients presented with prolonged HC for more than 35 days. Nine patients with evidence of cytomegalovirus （CMV） reactivation did not respond to anti-viral therapy even with CMV clearance in the urine post-therapy. Eleven patients with refractory HC received a low dose of corticosteroids and all patients went into complete remission. Conclusion Our data suggest that alloimmune injury is involved in the pathogenesis of HC in at least some patients and that specific therapy might improve the clinical outcome of hemorrhagic cystitis.展开更多
Background The cause of late-onset hemorrhagic cystitis （LOHC） after allogeneic hematopoietic stem cell transplantation （allo-HSCT） remains obscure. In clinical practice, some LOHC patients respond to immunosuppre...Background The cause of late-onset hemorrhagic cystitis （LOHC） after allogeneic hematopoietic stem cell transplantation （allo-HSCT） remains obscure. In clinical practice, some LOHC patients respond to immunosuppression.The aim of this study was to determine the immune pathogenesis of LOHC post allo-HSCT.Methods With the diagnosis of LOHC, patients were given initial treatment consisting of fluid hydration, alkalization and forced diuresis, and empirical anti-viral therapy for 10-14 days or until a week after the virus became negative. The nonresponders were applied corticosteroid. Seven to ten days later, patients＇ response was evaluated. Along with treatment, CD19^＋ B lymphocyte subsets were measured at various study points.Results From October 2009 to March 2010, we found 28 cases of LOHC occurred in 25 patients who underwent allo-HSCT in our hospital. Except that three cases were not treated according to the protocol, the other 25 cases were divided into three groups： anti-virus responders （Group A, n=6）, corticosteroid responders （Group B1, n=16）,corticosteroid and anti-virus nonresponders （Group C, n=3） according to their clinical response. Percentages of CD19^＋CD5^＋ B lymphocytes were not significantly different among three groups at onset of LOCH. However, in Group B1after the first anti-virus phase, percentages of CD19^＋CD5^＋ lymphocytes significantly increased comparing with those at onset （P=0.022）, and then significantly decreased at PR （P=0.003） and CR （P=0.002） with corticosteroid treatment. But significant change was not observed in Groups A and C.Conclusion The immune etiology seems to be involved in the development of LOHC and the proportion of CD19^＋CD5^＋lymphocytes may serve as a cellular biomarker to predict the response to corticosteroid in LOHC展开更多
Hemorrhagic cystitis(HC)is a common complication of allogeneic hematopoietic stem cell transplantation(HSCT).The incidence is about 7%to 68%,and some patients have to suffer a long period of frequent,urgent,and painfu...Hemorrhagic cystitis(HC)is a common complication of allogeneic hematopoietic stem cell transplantation(HSCT).The incidence is about 7%to 68%,and some patients have to suffer a long period of frequent,urgent,and painful urination,which brings great pain.This study aimed to analyze risk factors of HC and its effect on patient survival.We collected the medical records of 859 patients who underwent HSCT at our hospital between August 2016 and August 2020.Patients with and without HC were matched using propensity score matching at a 1:1 ratio based on sex,age,and diagnosis,and logistic regression analyses were used to identify factors associated with HC.We used Kaplan–Meier curves to analyze the survival rates of patients in the HC and non-HC groups.We also analyzed the relationship between BK viral load and the occurrence of HC using receiver operating characteristic curve(ROC)analysis.After propensity score matching,there were 131 patients each in the HC and non-HC groups.In the HC group,89 patients(67.9%)had mild HC(stage II°)and 43(32.1%)had severe HC(stage III–IV).The median interval between stem cell transplantation and HC development was 31(3–244)days.Univariate analysis indicated that donor age,hematopoietic stem cell source,HLA,acute graft-versus-host disease,busulfan,anti-thymocyte globulin(ATG),total body irradiation,cytomegalovirus(CMV)(urine),and BK polyomavirus(BKV)(urine)were significantly associated with HC.ATG,CMV(urine),and BKV(urine)were independent risk factors for HC based on the multivariate analysis.The Kaplan–Meier survival analysis showed no significant difference between the HC and non-HC groups(P=0.14).The 1-and 2-year survival rates in the HC group were 78.4%and 69.6%,respectively,and the corresponding rates in the non-HC group were 84.4%and 80.7%,respectively.ROC analysis indicated that a urine BKV load of 1×10^(7) copies/mL was able to stratify the risk of HC.In conclusion,when the BKV load is>1×10^(7),we needtobe aware of the potential for the development of HC.展开更多
The manuscript by Xu et al addresses an important question in the field of allogeneic hematopoietic progenitor cell transplantation （HPCT）： how to identify those patients at risk for hemmoraghic cystitis. The autho...The manuscript by Xu et al addresses an important question in the field of allogeneic hematopoietic progenitor cell transplantation （HPCT）： how to identify those patients at risk for hemmoraghic cystitis. The authors performed a retrospective analysis of 250 patients undergoing allogeneic HPCT following myeloablative conditioning with busulfan and cyclophosphamide using a standard post-transplant immunoprophylaxis with cyclosporine, short-course methotrexate and mycophenylate. Post-transplant hematuria was relatively common, occurring in 29% of allogeneic transplant recipients in this single institution series. Most of the documented hematuria was macroscopic （68% of cases）,展开更多
目的探讨间质性膀胱炎的临床病理学特征。方法收集33例间质性膀胱炎(实验组)的临床资料,并随机选取24例非膀胱肿瘤患者的活检标本作为对照组,镜下观察HE形态,并行甲苯胺蓝染色及免疫组化染色。结果实验组患者年龄40~79岁,中位年龄62岁,...目的探讨间质性膀胱炎的临床病理学特征。方法收集33例间质性膀胱炎(实验组)的临床资料,并随机选取24例非膀胱肿瘤患者的活检标本作为对照组,镜下观察HE形态,并行甲苯胺蓝染色及免疫组化染色。结果实验组患者年龄40~79岁,中位年龄62岁,仅1例为男性,余均为女性,其中20例(占61%)患者曾有盆腔和(或)腹腔手术史。对照组患者平均年龄68岁,其中男性19例,女性5例。镜下实验组和对照组均可见上皮糜烂伴急慢性炎细胞浸润,但实验组黏膜下层出血明显高于对照组(70%vs 17%,P<0.001),且实验组黏膜下层或肌层浸润的肥大细胞的数量显著高于对照组(24.8±16.6/HPF vs 0.31±1.08/HPF,P<0.001)。结论间质性膀胱炎患者仍需根据病史进一步细分,如是否合并自身免疫性疾病等,以更好地指导患者的治疗。展开更多
文摘Background: Radiotherapy is one of the most popular treatments for pelvic malignancy, which causes patients suffering from the adverse effect such as cystitis, hematuria, proctitis, hematochezia and distal ureteric stricture. The hematuria condition from radiation-induced hemorrhagic cystitis is the most common adverse event suffering the patients, losing properties, wasting time, and deteriorating quality of life. One of the most effective treatments for radiation-induced hemorrhagic cystitis is the hyperbaric oxygen therapy with no necessity for patients to be hospitalized, no need of anesthesia use, and also non-invasion. However, it requires that patients spend 90 - 120 minutes a day for 40 days administered out-patient treatment session. The transportation cost as well as the accommodation one will greatly burden the self-pay health care patients. In addition, there is still no definite standardized number of HBOT treatment session assignment at present. Objectives: To compare the treatment outcome (bladder mucosal characteristics, red blood cells in urine) between 30 and 40 sessions of HBOT for treatment of radiation-induced hemorrhagic cystitis. Methods: Prospective cohort observational study of patients (n = 15) who were diagnosed with radiation-induced hemorrhagic cystitis that were treated with hyperbaric oxygen therapy in Somdechprapinklao Hospital between October 2020 and September 2021. We compared the parameter about hemoglobin concentration, red blood cell number in urine during the course of HBOT treatment every 10 sessions and cystoscopic finding severity as EORTC/RTOG classification for radiation-induced hemorrhagic cystitis in Table 1 before treatment, and after 30 and 40 sessions of treatment. Results: From 15 of treated patients, 93.3% of patients had evidence of posterior wall lesion. The mean duration from radiotherapy (radiation and brachytherapy) to the first episode gross hematuria is 112 months. This study shows no statistically different cystoscopic findings as EORTC/RTOG classification for radiation-induced hemorrhagic cystitis after 30 and 40 sessions of HBOT (p = 0.653) and statistically significant improvement after the treatment of more than 30 sessions (p = 0.008). No relationship was found with the hemoglobin concentration and red blood cell number in urine during the course of HBOT. Conclusions: Radiation-induced hemorrhagic cystitis can be treated with HBOT. There is no different treatment outcome between 30 and 40 sessions of HBOT.
文摘BACKGROUND The advanced first-line regimen for advanced gastric cancer is based on a combination of fluoropyrimidine and platinum and/or paclitaxel(PTX),forming a two-or three-drug regimen.Compared to conventional PTX,nanoparticle albumin-bound PTX(Nab-PTX)has better therapeutic effects and fewer adverse effects reported in studies.Nab-PTX is a great option for patients presenting with advanced gastric cancer.Herein,we highlight an adverse event(hemorrhagic cystitis)of Nab-PTX in advanced gastric cancer.CASE SUMMARY A 55-year-old male was diagnosed with lymph node metastasis after a laparo-scopic-assisted radical gastrectomy for gastric cancer that was treated by Nab-PTX and S-1(AS).On the 15th day after treatment with AS,he was diagnosed with hemorrhagic cystitis.CONCLUSION Physicians should be aware that hemorrhagic cystitis is a potential adverse event associated with Nab-PTX treatment.
文摘Objective To investigate the efficacy and safety of the optimal alkalized hydration solution for hemorrhagic cystitis ( HC) following unrelated donor allogeneic hem-
基金supported by the grants from the Scientific Research fund for Capital Medicine Development(No. 2006-1010)the Hi-Tech Research and Development Program of China (No.2006AA02Z4A0).
文摘Background 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 alIo-HSCT and analyzed its association with CMV reactivation and GVHD. Methods We retrospectively studied 250 patients at high risk for CMV disease who underwent alIo-HSCT all based on busulfan/cyclophosphamide （BU/CY） myloablative regimens. The incidence, etiology, risk factors and clinical management of HC were investigated. Results 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. Conclusions 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.
文摘Background The pathophysiology of late-onset hemorrhagic cystitis （LOHC） is currently not well understood. The aim of this study was to analyze the alloimmune aetiology in the pathogenesis of LOHC post allogeneic hematopoietic stem cell transplantation （HSCT）. Methods A retrospective study was performed on the medical records of 11 patients with immune-related LOHC post allogeneic HSCT. The clinical characteristics, therapy, and outcomes of these patients were analyzed. Results The median time of onset was 42 days after HSCT （range 16-150 days） and the median duration of HC was 43 days （range 29-47 days）. All patients presented with prolonged HC for more than 35 days. Nine patients with evidence of cytomegalovirus （CMV） reactivation did not respond to anti-viral therapy even with CMV clearance in the urine post-therapy. Eleven patients with refractory HC received a low dose of corticosteroids and all patients went into complete remission. Conclusion Our data suggest that alloimmune injury is involved in the pathogenesis of HC in at least some patients and that specific therapy might improve the clinical outcome of hemorrhagic cystitis.
文摘Background The cause of late-onset hemorrhagic cystitis （LOHC） after allogeneic hematopoietic stem cell transplantation （allo-HSCT） remains obscure. In clinical practice, some LOHC patients respond to immunosuppression.The aim of this study was to determine the immune pathogenesis of LOHC post allo-HSCT.Methods With the diagnosis of LOHC, patients were given initial treatment consisting of fluid hydration, alkalization and forced diuresis, and empirical anti-viral therapy for 10-14 days or until a week after the virus became negative. The nonresponders were applied corticosteroid. Seven to ten days later, patients＇ response was evaluated. Along with treatment, CD19^＋ B lymphocyte subsets were measured at various study points.Results From October 2009 to March 2010, we found 28 cases of LOHC occurred in 25 patients who underwent allo-HSCT in our hospital. Except that three cases were not treated according to the protocol, the other 25 cases were divided into three groups： anti-virus responders （Group A, n=6）, corticosteroid responders （Group B1, n=16）,corticosteroid and anti-virus nonresponders （Group C, n=3） according to their clinical response. Percentages of CD19^＋CD5^＋ B lymphocytes were not significantly different among three groups at onset of LOCH. However, in Group B1after the first anti-virus phase, percentages of CD19^＋CD5^＋ lymphocytes significantly increased comparing with those at onset （P=0.022）, and then significantly decreased at PR （P=0.003） and CR （P=0.002） with corticosteroid treatment. But significant change was not observed in Groups A and C.Conclusion The immune etiology seems to be involved in the development of LOHC and the proportion of CD19^＋CD5^＋lymphocytes may serve as a cellular biomarker to predict the response to corticosteroid in LOHC
基金the National Natural Science Foundation of China(81670171 and 82070192)Key Project of Tianjin Natural Science Foundation(20JCZDJC00410)thrombocytopenia funding from the Yeehong Business School of Shenyang Pharmaceutical University(Sansheng TCP Young Research Funding,No.57).
文摘Hemorrhagic cystitis(HC)is a common complication of allogeneic hematopoietic stem cell transplantation(HSCT).The incidence is about 7%to 68%,and some patients have to suffer a long period of frequent,urgent,and painful urination,which brings great pain.This study aimed to analyze risk factors of HC and its effect on patient survival.We collected the medical records of 859 patients who underwent HSCT at our hospital between August 2016 and August 2020.Patients with and without HC were matched using propensity score matching at a 1:1 ratio based on sex,age,and diagnosis,and logistic regression analyses were used to identify factors associated with HC.We used Kaplan–Meier curves to analyze the survival rates of patients in the HC and non-HC groups.We also analyzed the relationship between BK viral load and the occurrence of HC using receiver operating characteristic curve(ROC)analysis.After propensity score matching,there were 131 patients each in the HC and non-HC groups.In the HC group,89 patients(67.9%)had mild HC(stage II°)and 43(32.1%)had severe HC(stage III–IV).The median interval between stem cell transplantation and HC development was 31(3–244)days.Univariate analysis indicated that donor age,hematopoietic stem cell source,HLA,acute graft-versus-host disease,busulfan,anti-thymocyte globulin(ATG),total body irradiation,cytomegalovirus(CMV)(urine),and BK polyomavirus(BKV)(urine)were significantly associated with HC.ATG,CMV(urine),and BKV(urine)were independent risk factors for HC based on the multivariate analysis.The Kaplan–Meier survival analysis showed no significant difference between the HC and non-HC groups(P=0.14).The 1-and 2-year survival rates in the HC group were 78.4%and 69.6%,respectively,and the corresponding rates in the non-HC group were 84.4%and 80.7%,respectively.ROC analysis indicated that a urine BKV load of 1×10^(7) copies/mL was able to stratify the risk of HC.In conclusion,when the BKV load is>1×10^(7),we needtobe aware of the potential for the development of HC.
文摘The manuscript by Xu et al addresses an important question in the field of allogeneic hematopoietic progenitor cell transplantation （HPCT）： how to identify those patients at risk for hemmoraghic cystitis. The authors performed a retrospective analysis of 250 patients undergoing allogeneic HPCT following myeloablative conditioning with busulfan and cyclophosphamide using a standard post-transplant immunoprophylaxis with cyclosporine, short-course methotrexate and mycophenylate. Post-transplant hematuria was relatively common, occurring in 29% of allogeneic transplant recipients in this single institution series. Most of the documented hematuria was macroscopic （68% of cases）,
文摘目的探讨间质性膀胱炎的临床病理学特征。方法收集33例间质性膀胱炎(实验组)的临床资料,并随机选取24例非膀胱肿瘤患者的活检标本作为对照组,镜下观察HE形态,并行甲苯胺蓝染色及免疫组化染色。结果实验组患者年龄40~79岁,中位年龄62岁,仅1例为男性,余均为女性,其中20例(占61%)患者曾有盆腔和(或)腹腔手术史。对照组患者平均年龄68岁,其中男性19例,女性5例。镜下实验组和对照组均可见上皮糜烂伴急慢性炎细胞浸润,但实验组黏膜下层出血明显高于对照组(70%vs 17%,P<0.001),且实验组黏膜下层或肌层浸润的肥大细胞的数量显著高于对照组(24.8±16.6/HPF vs 0.31±1.08/HPF,P<0.001)。结论间质性膀胱炎患者仍需根据病史进一步细分,如是否合并自身免疫性疾病等,以更好地指导患者的治疗。
