Hemorrhagic cystitis in children treated with alkylating agent cyclophosphamide: The experience of a medical center in Taiwan.
BACKGROUND/PURPOSE
Hemorrhagic cystitis is a common complication with chemotherapeutic alkylating agents. We investigated the possible prognostic factors of cyclophosphamide-induced hemorrhagic cystitis in children.


METHODS
Medical records of children (< 18 years old) with cyclophosphamide-related hemorrhagic cystitis were collected retrospectively from January 2000 to December 2010 in a tertiary care center. We also prospectively enrolled children (< 18 years old) with cyclophosphamide treatment.


RESULTS
The retrospective study consisted of 23 patients whose median age was 11 years. The median day of onset time was 1 day after cyclophosphamide usage. The hemato-oncological diseases included acute leukemia (39.1%), lymphoma (13%), blastoma (13%), sarcoma (13%), aplastic anemia (13%), and others (8.7%). Patients who received bone marrow transplantation (BMT) had significantly longer duration of hemorrhagic cystitis than those who did not receive BMT (p < 0.05). Serum uric acid, checked prior to and after the onset of hemorrhage cystitis, was significantly lower after the development of hemorrhagic cystitis (p < 0.05). In the prospective study, 11 children were enrolled with a median age of 5 years. The urinary nitrite/nitrate and 8-iso-prostaglandin F2α levels increased significantly after cyclophosphamide usage (p < 0.05).


CONCLUSION
Alteration serum uric acid level and BMT could be indicators for severe hemorrhagic cystitis. The elevated levels of urinary nitrite/nitrate and 8-iso-prostaglandin F2α may indicate the essential roles played by nitric oxide syntheses and reactive oxidative stress in cyclophosphamide-induced hemorrhagic cystitis. These findings may help clinicians formulate a better strategy for treating cyclophosphamide-induced hemorrhagic cystitis.
['Wang|Ching-Chia|CC|', 'Weng|Te-I|TI|', 'Lu|Meng-Yao|MY|', 'Yang|Rong-Sen|RS|', 'Lin|Kai-Hsin|KH|', 'Wu|Mei-Hwan|MH|', 'Liu|Shing-Hwa|SH|']
D000293:Adolescent D018906:Antineoplastic Agents, Alkylating D016026:Bone Marrow Transplantation D002648:Child D002675:Child, Preschool D003520:Cyclophosphamide D003556:Cystitis D005260:Female D006470:Hemorrhage D006801:Humans D008297:Male D010865:Pilot Projects D011446:Prospective Studies D012189:Retrospective Studies D013624:Taiwan D062606:Tertiary Care Centers D014527:Uric Acid D001743:Urinary Bladder
hemorrhagic cystitis cyclophosphamide uric acid nitric oxide