1. Risk factors for hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation in a letermovir-exposed CMV-free population receiving PTCy
- Author
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Galli, Eugenio, Metafuni, Elisabetta, Gandi, Carlo, Limongiello, M. A., Giammarco, S., Mattozzi, Andrea, Santangelo, Rosaria, Bacigalupo, Andrea, Sora', Federica, Chiusolo, Patrizia, Sica, Simona, Galli, E., Metafuni, E., Gandi, C., Mattozzi, A., Santangelo, R. (ORCID:0000-0002-8056-218X), Bacigalupo, A. (ORCID:0000-0002-9119-567X), Sora', F. (ORCID:0000-0002-9607-5298), Chiusolo, P. (ORCID:0000-0002-1355-1587), Sica, S. (ORCID:0000-0003-2426-3465), Galli, Eugenio, Metafuni, Elisabetta, Gandi, Carlo, Limongiello, M. A., Giammarco, S., Mattozzi, Andrea, Santangelo, Rosaria, Bacigalupo, Andrea, Sora', Federica, Chiusolo, Patrizia, Sica, Simona, Galli, E., Metafuni, E., Gandi, C., Mattozzi, A., Santangelo, R. (ORCID:0000-0002-8056-218X), Bacigalupo, A. (ORCID:0000-0002-9119-567X), Sora', F. (ORCID:0000-0002-9607-5298), Chiusolo, P. (ORCID:0000-0002-1355-1587), and Sica, S. (ORCID:0000-0003-2426-3465)
- Abstract
Hemorrhagic cystitis (HC) is a highly impacting complication in allogeneic hematopoietic stem cell transplantation (HSCT), occurring in 12%–37% of patients. The impact of transplant- and patient-specific variables has been described, with a possible role for JCV and BKV, which may be cooperating with cytomegalovirus (CMV). Here, we analyze 134 letermovir-exposed, CMV-free patients, treated with the same cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis, describing risk factors for HC. The overall incidence of HC was 23%. Patients with HLA mismatched transplant, higher comorbidity score, and receiving three alkylating agents with TBF (thiotepa, busulfan, and fludarabine) conditioning regimen had a higher risk of HC in multivariate analysis (OR: 4.48, 6.32, and 1.32, respectively). A HC-score including male gender, TBF conditioning, and HLA-mismatch stratifies the risk of HC in the first 100 days after HSCT. The role of BKV and JCV was not highly impacting in those patients, suggesting a possible synergistic effect between CMV and JCV in causing HC. HC can be interpreted as the combination of patient-related factors, chemotherapy-related toxicities—especially due to alkylating agents—and immunological elements.
- Published
- 2024