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Hemorrhagic Cystitis in Pediatric Cancer

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According to the research linked below, hemorrhagic cystitis in pediatric cancer patients who undergo a hematopoietic stem cell transplant occurs about 25% of the time if the patient undergoes an allogenic stem cell transplant. I will make the case that it happens more often than oncology documents.

I am a long-term cancer survivor. I have been struggling with hemorrhagic cystitis aka irritable bladder since I underwent those chemotherapy regimens associated with this long-term side effect.

If you want to imagine what HC feels like wait until you have to urinate. Now imagine that feeling every minute of the day except for about the first 30 minutes after you pee.

I have no experience with HC in pediatric cancer patients compared to adult cancer patients. I do, however, have personal experience living with HC. Further, I have experience with oncology and its attitudes toward late stage side effects. If HC is a common side effect in adult cancer survivors my belief is that hemorrhagic cystitis in pediatric cancer patients is a serious problem as well.

In short I believe that oncology has little incentive or desire to learn about the short, long-term and late side effects caused by toxic therapies approved as “safe and effective” by the FDA.

There are a number of evidence-based non-conventional therapies shown to reduce or even prevent HC in cancer patients.

These therapies are not discussed nor prescribed simply because  they are not approved by the FDA.

What are the possible causes of hemorrhagic cystitis?

  1. Infection: Viral infections, particularly with adenovirus, can cause hemorrhagic cystitis. Other pathogens like bacteria and fungi can also lead to inflammation and bleeding in the bladder.
  2. Chemotherapy: Certain chemotherapy drugs, especially those used in the treatment of cancer, can irritate the bladder lining, leading to hemorrhagic cystitis. Cyclophosphamide and ifosfamide are commonly associated with this side effect.
  3. Radiation therapy: Radiation therapy to the pelvic area, often used in the treatment of various cancers such as prostate, bladder, or cervical cancer, can damage the bladder lining, leading to bleeding.
  4. Bladder Trauma: Any trauma or injury to the bladder, whether due to surgery, catheterization, or other causes, can cause inflammation and bleeding.
  5. Chemical Irritants: Exposure to certain chemicals or toxins can irritate the bladder lining, leading to inflammation and bleeding. This can include ingesting certain medications, like nonsteroidal anti-inflammatory drugs (NSAIDs) or consuming substances like cyclophosphamide.
  6. Urinary Tract Obstruction: Any obstruction in the urinary tract, such as kidney stones or tumors, can cause urine to back up into the bladder, leading to irritation and bleeding.
  7. Autoimmune Disorders: Conditions like lupus or Wegener’s granulomatosis, which cause inflammation and damage to blood vessels, can also lead to hemorrhagic cystitis.
  8. Other Medical Conditions: Certain medical conditions like diabetes or hypertension can predispose individuals to bladder problems, which could potentially lead to hemorrhagic cystitis.

I had an autologous stem cell transplant. In addition, I underwent busulfan as well a cytoxan/cyclophosphomide chemotherapy regimens. Each of these therapies brings a risk of HC.

Therapies to heal Hemorrhagic Cystitis?

Are you a pediatric cancer patient about to undergo an allogeneic stem cell transplant? Are you a pediatric cancer patient dreading the possibility of developing hemorrhagic cystitis? If you would like to learn more about HC email me at David.PeopleBeatingCancer@gmail.com

Hang in there,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Risk factors for hemorrhagic cystitis in children undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis

“Background– The risk factors for hemorrhagic cystitis (HC) in children undergoing hematopoietic stem cell transplantation (HSCT) are unclear. Therefore, we conducted this systematic review and meta-analysis to investigate the risk factors for HC in children undergoing HSCT.

Methods- We performed this meta-analysis by retrieving studies from PubMed, EMBASE, and the Cochrane Library up to October 10, 2023, and analyzing those that met the inclusion criteria. I2 statistics were used to evaluate heterogeneity.

Results- Twelve studies, including 2,764 patients, were analyzed. Male sex (odds ratio [OR] = 1.52; 95% confidence interval [CI], 1.16–2.00; p = 0.003, I2 = 0%), allogeneic donor (OR = 5.28; 95% CI, 2.60–10.74; p < 0.00001, I2 = 0%), human leukocyte antigen (HLA) mismatched donor (OR = 1.86; 95% CI, 1.00–3.44; p = 0.05, I2 = 31%), unrelated donor (OR = 1.58; 95% CI, 1.10–2.28; p = 0.01, I2 = 1%), myeloablative conditioning (MAC) (OR = 3.17; 95% CI, 1.26–7.97; p = 0.01, I2 = 0%), busulfan (OR = 2.18; 95% CI, 1.33–3.58; p = 0.002, I2 = 0%) or anti-thymoglobulin (OR = 1.65; 95% CI, 1.07–2.54; p = 0.02, I2 = 16%) use, and cytomegalovirus (CMV) reactivation (OR = 2.64; 95% CI, 1.44–4.82; p = 0.002, I2 = 0%) were risk factors for HC in children undergoing HSCT.

Conclusions- Male sex, allogeneic donor, HLA-mismatched, unrelated donor, MAC, use of busulfan or anti-thymoglobulin, and CMV reactivation are risk factors for HC in children undergoing HSCT…

Hemorrhagic cystitis (HC) is a frequent complication in patients undergoing HSCT, significantly diminishing their quality of life and extending the length of their hospital stay [2]. Moreover, severe HC is associated with higher mortality [3].

HC is categorized into two groups based on its onset time:

  1. early-onset (within 72 h) and
  2. late-onset (more than 72 h after conditioning) [4].

The reported incidence rates of HC in pediatric HSCT recipients vary between 3% and 27% [5, 6]. The clinical presentation of HC varies. Mild cases may manifest only as microscopic hematuria, whereas severe cases can manifest as life-threatening complications characterized by continuous bleeding and urinary tract obstruction [7]. The risk factors for HC include age, receipt of cells from an unrelated donor, and the occurrence of acute graft-versus-host disease (GVHD) [8, 9]…

The types of HSCT include autologous and allogeneic, owing to the different sources of stem cells (the patients or others). Recipients of allogeneic transplantation may have a higher incidence of HC [14, 26], which is consistent with our results. We speculate that this association may be attributable to the higher dose of cyclophosphamide (which can injure the bladder mucosa) employed in the conditioning regimen of allogeneic transplant recipients…

Conclusions- Our meta-analysis suggested that male sex, allogeneic donor, HLA-mismatched donor, unrelated donor, MAC, use of busulfan or ATG, and CMV reactivation were potential risk factors for HC in pediatric HSCT recipients.”

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