Prostaglandin E2 bladder instillation for the treatment of hemorrhagic cystitis after allogeneic bone marrow transplantation

Bone Marrow Transplant Unit, University of Florence, Azienda Ospedaliera di Careggi, Italy.

BACKGROUND. Hemorrhagic cystitis (HC) is a major complication of high-dose cyclophosphamide therapy used in the preparative regimen for allogeneic or autologous bone marrow transplantation. Several viruses (adenovirus, cytomegalovirus and polyomavirus BK) have also been implicated in the etiology of HC. No one established method of treatment is as yet available. MATERIALS AND METHODS. HC developed in 10 patients after allogeneic bone marrow transplantation and was BK viruria-associated in all cases. All patients were treated with instillations of prostaglandin E2 (PGE2) directly into the bladder. RESULTS. A complete resolution of hematuria within a short time (5 +/- 1 days) was observed in all cases; in 4/10 patients urine cleared within 24 hours of the initial treatment. Intravesical PGE2 therapy caused no systemic circulatory or respiratory problems, although bladder spasms occurred in all patients. CONCLUSIONS. Intravesical prostaglandin E2 instillation appears to be an effective treatment for hemorrhagic cystitis in bone marrow transplant patients; further studies are required to assess the actual role of BK virus in the pathogenesis of HC in bone marrow transplant patients.