The following is a summary of “Risk Factors for Mortality in Children with Hemorrhagic Cystitis after Hematopoietic Transplant,” published in the February 2024 issue of Pediatrics by Salevitz et al.

Hemorrhagic cystitis (HC) represents a significant complication following bone marrow (BMT) and stem cell transplant (SCT), with a substantial impact on patient outcomes. While existing literature predominantly focuses on adult populations, there remains a gap in understanding the risk factors associated with mortality and morbidity in pediatric HC patients.

This study aimed to investigate factors contributing to all-cause mortality in children experiencing HC following BMT/SCT.

Utilizing the Pediatric Health Information System database, the researchers identified patients with ICD-9/10 codes indicative of hematopoietic transplant and HC-related symptoms. Multivariable logistic regression analyses were conducted to assess the association between various medical and surgical interventions commonly utilized for HC management and mortality and genitourinary (GU) morbidity, defined as the receipt of bladder medication instillation or GU procedures.

In total, 811 patients with a mean age of 12.4 years and a majority (62%) male were included in the study. Primary diagnoses encompassed a range of conditions, with leukemia/lymphoma comprising the largest proportion (49%). Notably, performing bladder instillation or any GU procedure was significantly associated with mortality. Multivariate analysis revealed that dialysis, GU morbidity, and intravenous cidofovir administration were significantly linked to increased all-cause mortality, while an underlying diagnosis of blood dyscrasia exhibited a protective effect.

Their retrospective analysis, inclusive of a large patient cohort, identified an all-cause mortality rate of 11% among children with HC, albeit potentially underestimated due to discharge-related data limitations. Findings underscored the lack of survival benefits associated with invasive GU interventions in severe HC cases. Limitations included inherent biases in retrospective data analysis and potential underrepresentation of out-of-hospital mortalities.

Children with HC undergoing dialysis, receiving intravenous cidofovir, or undergoing GU interventions faced heightened all-cause mortality risks. Given the severity of high-grade HC, urologists and oncologists should prioritize interventions aimed at enhancing the quality of life while avoiding futile treatments in this vulnerable patient population.

Source: sciencedirect.com/science/article/abs/pii/S1477513124000913