TY - JOUR
T1 - Risk factors for hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation in a letermovir-exposed CMV-free population receiving PTCy
AU - Galli, Eugenio
AU - Metafuni, Elisabetta
AU - Gandi, Carlo
AU - Limongiello, Maria Assunta
AU - Giammarco, Sabrina
AU - Mattozzi, Andrea
AU - Santangelo, Rosaria
AU - Bacigalupo, Andrea
AU - Sora', Federica
AU - Chiusolo, Patrizia
AU - Sica, Simona
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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.
KW - CMV
KW - allogeneic hematopoietic stem cell transplantation
KW - hemorrhagic cystitis
KW - letermovir
KW - CMV
KW - allogeneic hematopoietic stem cell transplantation
KW - hemorrhagic cystitis
KW - letermovir
UR - http://hdl.handle.net/10807/262737
U2 - 10.1111/ejh.14147
DO - 10.1111/ejh.14147
M3 - Article
SN - 0902-4441
SP - N/A-N/A
JO - European Journal of Haematology
JF - European Journal of Haematology
ER -