摘要
Background The cause of late-onset hemorrhagic cystitis （LOHC） after allogeneic hematopoietic stem cell transplantation （allo-HSCT） remains obscure. In clinical practice, some LOHC patients respond to immunosuppression.The aim of this study was to determine the immune pathogenesis of LOHC post allo-HSCT.Methods With the diagnosis of LOHC, patients were given initial treatment consisting of fluid hydration, alkalization and forced diuresis, and empirical anti-viral therapy for 10-14 days or until a week after the virus became negative. The nonresponders were applied corticosteroid. Seven to ten days later, patients＇ response was evaluated. Along with treatment, CD19^＋ B lymphocyte subsets were measured at various study points.Results From October 2009 to March 2010, we found 28 cases of LOHC occurred in 25 patients who underwent allo-HSCT in our hospital. Except that three cases were not treated according to the protocol, the other 25 cases were divided into three groups： anti-virus responders （Group A, n=6）, corticosteroid responders （Group B1, n=16）,corticosteroid and anti-virus nonresponders （Group C, n=3） according to their clinical response. Percentages of CD19^＋CD5^＋ B lymphocytes were not significantly different among three groups at onset of LOCH. However, in Group B1after the first anti-virus phase, percentages of CD19^＋CD5^＋ lymphocytes significantly increased comparing with those at onset （P=0.022）, and then significantly decreased at PR （P=0.003） and CR （P=0.002） with corticosteroid treatment. But significant change was not observed in Groups A and C.Conclusion The immune etiology seems to be involved in the development of LOHC and the proportion of CD19^＋CD5^＋lymphocytes may serve as a cellular biomarker to predict the response to corticosteroid in LOHC
Background The cause of late-onset hemorrhagic cystitis （LOHC） after allogeneic hematopoietic stem cell transplantation （allo-HSCT） remains obscure. In clinical practice, some LOHC patients respond to immunosuppression.The aim of this study was to determine the immune pathogenesis of LOHC post allo-HSCT.Methods With the diagnosis of LOHC, patients were given initial treatment consisting of fluid hydration, alkalization and forced diuresis, and empirical anti-viral therapy for 10-14 days or until a week after the virus became negative. The nonresponders were applied corticosteroid. Seven to ten days later, patients＇ response was evaluated. Along with treatment, CD19^＋ B lymphocyte subsets were measured at various study points.Results From October 2009 to March 2010, we found 28 cases of LOHC occurred in 25 patients who underwent allo-HSCT in our hospital. Except that three cases were not treated according to the protocol, the other 25 cases were divided into three groups： anti-virus responders （Group A, n=6）, corticosteroid responders （Group B1, n=16）,corticosteroid and anti-virus nonresponders （Group C, n=3） according to their clinical response. Percentages of CD19^＋CD5^＋ B lymphocytes were not significantly different among three groups at onset of LOCH. However, in Group B1after the first anti-virus phase, percentages of CD19^＋CD5^＋ lymphocytes significantly increased comparing with those at onset （P=0.022）, and then significantly decreased at PR （P=0.003） and CR （P=0.002） with corticosteroid treatment. But significant change was not observed in Groups A and C.Conclusion The immune etiology seems to be involved in the development of LOHC and the proportion of CD19^＋CD5^＋lymphocytes may serve as a cellular biomarker to predict the response to corticosteroid in LOHC
