Multivariate Analysis Of Risk Factors For Hemorrhagic Cystitis After Allogeneic Hematopoietic Stem Cell Transplantation

Objective: To analyze the risk factors of clinically overt HC(grade ≥II)in 114 patients undergoing allo-HSCT to predict the occurrence of HC and establish the most appropriate prophylactic therapy.Methods: We retrospectively analyzed 29 cases of clinically overt HC from a series of 114 patients with allo-HSCT from April, 1997 to December, 2004. The time of follow-up began from the day of initiating conditioning to day +180 post-transplant. The 11 clinical parameters were selected for univariate analysis: age, sex, underlying disease, conditioning regimen, disease status at transplant, aGVHD, donor type, use of ATG, grade II ~ IV aGVHD prophylaxis, platelet engraftment, neutrophil engraftment. Factors that were significant at the 0.1 level on univariate analysis were evaluated by multivariate analysis using a Cox regression. The cumulative incidence of grade II or greater HC within the day 180 after transplantation was calculated by the method of Kaplan and Meier. Results: 1 29 of 114 patients developed HC with grade II in 12/29 cases (41.4%), grade III in 11/29 (37.9%) and grade IV in 6/29 (20.7%). The overall incidence of HC was 26%. 23 were males and 6 were females. The median day of onset of HC was 44 days, ranging between day— 1 and day+165, lasting from 7 to 60 days. 2 The following factors were associated with an increased risk of HC by univariate analysis: (1) male gender (RR=2.855, P=0.021); (2) younger than 26 years (RR=3.265, P=0.007); (3) grade III-IV aGVHD (RR=4.039, P = 0.002); (4) unrelated doner (RR=4.347, P=0); (5) intense GVHD prophylaxis (RR=2.218, P=0.045); (6) advanced disease (RR=2.668, P=0.009). 3 These risk factors were entered into a multivariate model. Only male gender (RR = 2.993, 95% CI 1.218-7.358; P=0.017) and unrelated donor (RR=4.478, 95% CI 2.049-9.786; P= 0.000) were identified as being significantly associated with the occurrence of hemorrhagic cystitis.Conclusion: we found that in multivariate analysis, patients were at increased risk of HC if they were male or had received graft from unrelated donors.