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      Nursing Management of Haemorrhagic Cystitis in Patients Undergoing Haematopoietic Stem Cell Transplantation: a Multicentre Italian Survey

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          Abstract

          Background

          Haemorrhagic cystitis (HC) is a severe complication occurring after haematopoietic stem cell transplantation (HSCT) in 13–40% of patients, caused by infectious and/or non-infectious factors that increase the in-hospital length of stay and the risk of mortality of transplanted recipients. Although different management interventions have been suggested in the literature, available knowledge on interventions performed by Italian nurses in their daily practices has not been documented to date.

          Aim of the study

          The aim of this study is to describe HC preventive and treatment interventions in patients undergoing HSCT as performed by Italian nurses in their daily practice.

          Material and methods

          A multicentre survey was conducted in 2018 by inviting all 110 Italian HSCT centres belonging to the Italian Group for Bone Marrow Transplantation (GITMO). Data collection was performed with an online questionnaire submitted to GITMO reference nurses working in each HSCT centre. Descriptive statistics were performed.

          Results

          A total of 38 Italian centres participated. The preventive intervention most applied in daily care was the mesna administration (n=37; 97.4%), followed by intravenous hyperhydration (n=33; 86.8%) and forced diuresis with furosemide (n=24; 63.1%). Preventive continuous bladder irrigation (CBI) was performed in 13 centres (34.2%). Transfusions of blood products (n=32; 84.2%), CBI (n=31; 81.6%) and intravenous hydration (n=28; 73.7%) were the most applied treatments, beyond the administration of analgesics (n=38; 100.0%) and antispasmodics (n=26; 68.4%).

          Conclusion

          A great variability both in the HC prevention and treatment interventions applied in daily practice across centres have emerged suggesting that no strong recommendations in the field are available to date. Therefore, there is a need to increase the evidence available in the field by providing methodological studies of higher quality, multicentre and prospective.

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          Most cited references41

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          Regimen-related toxicity in patients undergoing bone marrow transplantation.

          Jan Buckner, R Clift, Rachel S Bearman … (1988)
          Bone marrow transplantation is associated with significant morbidity and mortality, some of which is due to high-dose chemoradiotherapy. In order to quantitate toxicity that was felt to be due to the preparative regimen (termed regimen-related toxicity [RRT]), a system was developed in which toxicities were graded from 0 (none) to 4 (fatal). One hundred ninety-five patients who underwent marrow transplantation for leukemia were studied retrospectively to determine whether toxicities that were clinically felt to be due to the preparative regimen were influenced by other factors such as disease status, graft-versus-host disease (GVHD) prophylaxis, and allogenicity. All patients developed grade I toxicity in at least one organ, and 30 developed grades III-IV (life-threatening or fatal) RRT. RRT was more common in relapsed patients v remission patients (P = .04), in those receiving 15.75 Gy total body irradiation (TBI) v 12.0 Gy TBI (P = .028), and in those receiving allogeneic marrow v autologous marrow (P = .0029). Autologous marrow recipients did not develop grades III-IV toxicity in this study. A multivariate analysis controlling for autologous marrow grafting showed that the dose of TBI was the only statistically significant predictor of grades III-IV RRT. Those patients who developed grade III RRT were unlikely to survive 100 days from transplant, though not all deaths could be attributed to RRT. Patients who developed grade II toxicity in three or more organs were more likely to die within 100 days than those developing grade II toxicity in two or less organs (P = .0027). This system was generally able to distinguish RRT from other toxicities observed in marrow recipients.
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            Polyomavirus BK infection in blood and marrow transplant recipients.

            Simon R M Jones, Lesia K Dropulic (2007)
            The association of BK virus infection with hemorrhagic cystitis in blood and marrow transplant (BMT) recipients was first demonstrated two decades ago. During this time, therapeutic interventions focused on supportive measures such as hyperhydration, continuous bladder irrigation and topical administration of agents that alter the mucosal surface of the bladder wall. In recent years, PCR amplification of viral DNA in the urine and plasma has solidified the association of BK virus infection with hemorrhagic cystitis, demonstrating that higher urine and plasma viral loads occur in the setting of disease. The evaluation of virus-specific therapy has lagged behind assessment of the viral load and theories of pathogenesis. Extrapolating from successes in the treatment of BK virus nephropathy in the renal transplant population, cidofovir and leflunomide are identified as potential effective agents for the treatment of BK virus-associated hemorrhagic cystitis. The fluoroquinolone antibiotics may prove to be effective as prophylactic agents. Given the manifestation of BK virus infection in organs outside of the urinary tract in an increasing immunocompromised patient population and the availability of potential antiviral agents, therapeutic trials need to progress beyond the small case series in order to improve the morbidity and mortality caused by BK virus-associated hemorrhagic cystitis in the BMT population.
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              Quality of life in patients before and after haematopoietic stem cell transplantation measured with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire QLQ-C30.

              H Bailer, C Albani, N. E. Grulke (2012)
              The EORTC Quality of Life Core Questionnaire QLQ-C30 is widely used, but no reference values are available for patients receiving HSCT. We retrieved data for 38 samples from 33 papers in English and German that provided evaluable information on QLQ-C30 scores (mean, s.d.) covering about 2800 patients. Results are presented as a table that provides reference data that allow QLQ-C30 scores at different points during the disease trajectory to be put in context. With respect to their central tendency and their variance, scores vary over time. Quality of life is lowest during inpatient time. About 1 year after HSCT, the pre-transplant level is reached. Physical functioning is the scale reaching the highest level of all scales. Fatigue, dyspnoea and insomnia are symptoms that remain at an elevated level and should thus be considered as persisting problems after HSCT. For the interpretation of differences between scores, a very conservative recommendation would be to set the s.d. at 30 points. Doing so, one could be quite sure of having found a clinically significant change if the difference of two scores exceeds 15 points. Differences below 5 points should be interpreted with caution.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Mediterr J Hematol Infect Dis
                Journal ID (iso-abbrev): Mediterr J Hematol Infect Dis
                Journal ID (publisher-id): Mediterranean Journal of Hematology and Infectious Diseases
                Title: Mediterranean Journal of Hematology and Infectious Diseases
                Publisher: Università Cattolica del Sacro Cuore
                ISSN (Electronic): 2035-3006
                Publication date Collection: 2019
                Publication date (Electronic): 01 September 2019
                Volume: 11
                Issue: 1
                Electronic Location Identifier: e2019051
                Affiliations
                [1 ]School of Nursing, Department of Medical Sciences, University of Udine, Italy
                [2 ]Hematology Unit, Azienda USL-IRCCS Reggio Emilia, Italy
                [3 ]Hematology and Haematopoietic Stem Cell Transplantation centre, “Federico II” University Hospital of Naples, Italy
                Author notes
                Correspondence to: PhDc Alvisa Palese, MNS. School of Nursing, Udine University, Viale Ungheria, 20, 33100 Udine, Italy; Tel.: +39 0432 590926; E-mail: alvisa.palese@ 123456uniud.it
                Article
                Publisher ID: mjhid-11-1-e2019051
                DOI: 10.4084/MJHID.2019.051
                PMC ID: 6736169
                SO-VID: c54be562-20cb-4be2-9e3d-c51d6e15ba7c
                Copyright statement: Copyright @ 2019
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 14 May 2019
                Date accepted : 08 August 2019
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: haematopoietic stem cell transplantation,haemorrhagic cystitis,italy,management,nursing,prevention,professional experience,supportive measures,survey,treatment
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: haematopoietic stem cell transplantation, haemorrhagic cystitis, italy, management, nursing, prevention, professional experience, supportive measures, survey, treatment

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