Cystitis, hemorrhagic

Clinical trials showed therapeutic efficacy in a broad spectrum of tumors these include SCLC, testicular tumors, sarcomas, breast cancer, renal cell cancer, pancreatic tumors and lymphomas. Ifosfamide is less myelosuppressive than cyclophosphamide but is more toxic to the bladder. Therefore it is recommended that ifosfamide is coadministered with the thiol compound mesna to avoid hemorrhagic cystitis and to reduce the risk of developing bladder cancer. Other side effects include neurotoxicity and myelosuppression. 

Few side effects can be alleviated by the use of antidotes. An example is the prevention of hemorrhagic cystitis caused by cyclophosphamide by the concomitant infusion of mesna. 

Cyclophosphamide Hemorrhagic cystitis due to acrolein metabolite (prevent with MESNA)... 

Alkylating agents Cyclophosphamide Myelosuppression, hemorrhagic cystitis Alopecia, stomatitis, amenorrhea, aspermia, secondary leukemias... 

CHOP Cyclophosphamide Alkylating agent Prodrug CYP 3A4/5, 2D6 Hemorrhagic cystitis... 

List the nonhematologic toxicity to high-dose chemotherapy used in myeloablative preparative regimens, specifically busulfan-induced seizures, hemorrhagic cystitis, gastrointestinal toxicities, and sinusoidal obstruction syndrome. 

The use of effective prevention strategies can decrease the incidence of hemorrhagic cystitis to less than 5% in patients receiving cyclophosphamide or ifosfamide. There are three methods to reduce the risk administration of mesna, hyperhydration, and bladder irrigation with catheterization. 

Twenty percent of patients receiving pelvic irradiation may experience hemorrhagic cystitis, especially with concurrent cyclophosphamide. Viral infections commonly associated with this condition occur most frequently in bone marrow transplant recipients who also may receive cyclophosphamide. 

If hemorrhagic cystitis occurs, the goals of treatment are to decrease exposure to the offending etiology, establish and maintain urine outflow, avoid obstruction and renal compromise, and maintain blood and plasma volume. Restoration of normal bladder function is the ultimate goal following acute treatment. 

Treatment of hemorrhagic cystitis. IV, intravenous. (Data from ref. 24.)... 

West NJ. Prevention and treatment of hemorrhagic cystitis. Pharmacotherapy 1997 17 696-706. 

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