Gonella, S., di Pasquale, T., & Palese, A. (2015). Preventive measures for cyclophosphamide-related hemorrhagic cystitis in blood and bone marrow transplantation: An Italian multicenter retrospective study. Clinical Journal of Oncology Nursing, 19, E8–E14.

DOI Link

Study Purpose

To determine the incidence of early onset hemorrhagic cystitis (EOHC) and identify the effectiveness of preventive measures upon EOHC

Intervention Characteristics/Basic Study Process

This retrospective study evaluated the effects of hyperhydration, diuresis alkalization, mesna, fluoroquinolone antibiotic prophylaxis, urethral catheterization, and CBI on 158 patients in two centers undergoing BMT regime upon EOHC. EOHC was defined as HC occurring within the 21 days after transplantation.

Sample Characteristics

  • N = 158  
  • MEAN AGE = 41.9 years
  • MALES: 59%, FEMALES: 41%
  • KEY DISEASE CHARACTERISTICS: Patients receiving conditioning BMT regimes for either autologous (n = 5) or allogeneic (n = 153) BMT for hematologic malignancies  
  • OTHER KEY SAMPLE CHARACTERISTICS: 40% of patients had AML.

Setting

  • SITE: Multi-site    
  • SETTING TYPE: Inpatient    
  • LOCATION: Italy

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Elder care

Study Design

  • Retrospective study of patients receiving BMT regimes at two Italian centers

Measurement Instruments/Methods

Groups were compared using the Mann-Whitney U test (for continuous variables) and Yates’ correction (for categorical variables). Logistic regression was used to identify factors contributing to the development of EOHC, including gender, age, smoking habits, type of transplantation, stem-cell donor, Cytoxan dose, urethral catheterization, and CBI. A multivariate regression model using a backward stepwise selection algorithm was employed.

Results

Thirty-one patients (all allogeneic transplantations) developed EOHC. Female gender (p = 0.24) and the dose of cytoxan (p = 0.016) were identified as independent risk factors for EOHC. The daily dose of mesna was the only significant measure (p = 0.01) identified between those who developed EOHC (median = 4.463) and those who did not (3.701).

Conclusions

Univariate analysis does not support the current standard, prophylactic catheterization and CBI, for prevention of EOHC. The best practice includes hyperhydration association with diuresis alkalization and mesna infusions.

Limitations

  • Unintended interventions or applicable interventions that would influence results were not described.
  • This was a retrospective study.

Nursing Implications

Nurses caring for patients at risk of HC may need to reassess current standards for prophylactic treatment of HC.