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A survey on the practices and the management of hemorrhagic cystitis in patients who undergo allogeneic hematopoietic stem cell transplantation, on behalf of the Infectious Diseases Working Party of EBMT

Bone Marrow Transplantation (2025)Cite this article

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Abstract

This survey reports on the current practice and management of hemorrhagic cystitis (HC) among the EBMT centers. The survey response rate was 27%. The diagnostic search of BK polyomavirus (BKPyV) was available in 93% of centers and performed in urine (100%), blood/plasma (51%), and serum (12%). Patient screening for BKPyV infection was performed in 14% of centers before hematopoietic cell transplantation (HCT). In comparison, surveillance for BKPyV infection was performed after HCT in 39% of centers, mainly with a frequency of 1–2 times/week. Preventative measures are based mainly on hyperhydration and sodium 2-mercaptoethanesulphonate (Mesna), while the use of bladder catheter is limited; moreover, 23% of centers used quinolones prophylaxis.The primary therapeutic interventions are hyperhydration, Mesna, analgesics, and sustained platelet transfusions; bladder irrigation by urinary catheter is adopted by 47–50% of centers. In the case of BKPyV infection, 85% of centers use intravenous or intrabladder administration of cidofovir at a dosage ranging from 1 to 5 mg/kg. Centers report a miscellaneous range of alternative therapeutic measures (adoptive immunotherapy, hyperbaric oxygen therapy, fibrin glue/platelet-rich plasma, leflunomide, sodium hyaluronate) and the need for invasive procedures. This survey confirms that the management of HC needs further education, clinical research, and innovation.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request after approval of the scientific board of The Infectious Diseases Working Party of EBMT.

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Acknowledgements

We acknowledge all EBMT centers participating to the survey. The centers are listed according to their identification code (CIC), principal investigator’s name, study reporter’s name, city, and country. CIC 104, Mathias Haenel and Simone Karp, Chemnitz, Germany; CIC 141 Domenico Russo and Gabriele Magliano, Brescia, Italy; CIC 145, Martin Kaufmann and Sandra Siegle, Stuttgart, Germany; CIC 159, Mohammed Marei and Hassan Alshehri, Riyadh, Saudi Arabia; CIC 161, Ron Ram, Tel Aviv, Israel; CIC 163, Daniele Vallisa, Piacenza, Italy; CIC 177, Oleksandr Lysytsia, Kyiv, Ukraine; CIC 188, Mani Ramzi, Shiraz, Iran; CIC 197, Astrid Olsnes Kittang, Bergen, Norway; CIC 202, Jacob Passweg and Nina Khanna, Basel, Switzerland; CIC 204, Elisa Sala, Ulm, Germany; CIC 207, Regis Peffault de Latour and Alienor Xhaard, Paris, France; CIC 209, Johan Maertens, Leuven, Belgium; CIC 217, Emanuele Angelucci and Malgorzata Mikulska, Genova, Italy; CIC 225, Maija Itala-Remes, Turku, Finland; CIC 227, Werner Rabitsch, Vienna, Austria; CIC 232, Anna Paola Iori, Rome, Italy; CIC 242, Arancha Bermudez Rogriguez and Guillermo Martin-Sanchez, Santander, Spain; CIC 245, Lucia Prezioso, Parma, Italy; CIC 246, Annoek Broers, Rotterdam, The Netherlands; CIC 250, Jerome Cornillon, Saint Etienne, France; CIC 252, Romain Gounot and Christine Robin, Creteil, France; CIC 254, Jennifer Clay, Leeds, United Kingdom; CIC 256, Friedrich Stolzel, Kiel, Germany; CIC 257, Catherine Flynn, Dublin, Ireland; CIC 260, Rodrigo Martino Bufarull and Albert Esquirol, Barcelona, Spain; CIC 261, Yves Chaladon and Dionysios Neofytos, Geneva, Switzerland; CIC 264, Xavier Leleu and Natacha Maillard, Poitiers, France; CIC 266, Kristina Carlson, Uppsala, Sweden; CIC 267, Edouard Forcade, Pessac, France; CIC 270, Claude Eric Bulabois, Grenoble, France; CIC 272, Emmanuel Gyan and Alban Villate, Tours, France; CIC 274, Maura Faraci, Genova, Italy; CIC 277, Ibrahim Yakoub-Agha and Valerie Coiteux, Lille, France; CIC 282, Carlos Solano Vercet and Jose Luis Pinana, Valencia, Spain; CIC 283, Stig Lenhoff, Lund, Sweden; CIC 287, Anna Proia, Rome, Italy; CIC 297, Gesine Bug, Frankfurt, Germany; CIC 300, Fernando Leal da Costa and Nuno Miranda, Lisboa, Portugal; CIC 304, Chiara Nozzoli and Ilaria Cutini, Firenze, Italy; CIC 307, Simona Sica and Elisabetta Metafuni, Rome, Italy; CIC 346, Boryana Avramova and Irena Vlahova, Sofia, Bulgaria; CIC 348, Edgar Jost, Aachen, Germany; CIC 352, Marc Bierings, Utrecht, The Netherlands, CIC 355, Serdar Bedii Omay and Yakup Unsal, Istanbul, Turkey; CIC 358, Dragana Vujic, Belgrade, Sofia; CIC 367, Friederike Wortmann, Luebeck, Germany; CIC 381, Borce Georgievski and Zlate Stojanoski, Skopje, North Macedonia; CIC 382, Joaquin Martinez Lopez and Maria Calbacho, Madrid, Spain; CIC 386, Caroline Besley, Bristol, United Kingdom; CIC 392, Luca Castagna, Palermo, Italy; CIC 397, Mahmoud Aljurf, Riyadh, Saudi Arabia; CIC 399, Duygu Uckan-Cetinkaya and Baris Kuskonmaz, Ankara, Turkey; CIC 401, Huang He, Hangzhou, China; CIC 409, Moshe Yeshurun, Petach-Tikva, Israel; CIC 415, Marta Stanzani, Treviso, Italy; CIC 427, Alina Tanase and Lipan Lavinia, Bucharest, Romania; CIC 428, Sebastian Giebel and Malgorzata Sobczyk-Kruszelnicka, Gliwice, Poland; CIC 434, Aloysius Ho, Singapore, Singapore; CIC 444, Mohsen Al Zahrani, Riyadh, Saudi Arabia; CIC 445, Leylagul Kaynar and Bilge Unal, Istanbul, Turkey; CIC 448, Tunc Fisgin and Rabia Taskale, Istanbul, Turkey; CIC 451, Trancisco Cuellar-Ambrosi, Medellin, Colombia; CIC 454, Ali Bulent Antmen, Adana, Turkey; CIC 459, Baris Malbora, Istanbul, Turkey; CIC 465, Rajat Argawal, Bangalore, India; CIC 468, Siret Ratip and Aysem Kuni, Istanbul, Turkey; CIC 505, Birgit Burkhardt and Andreas Groll, Muenster, Germany; CIC 515, Urpu Salmenniemi, Helsinki, Finland; CIC 525, Natalia Maximova, Trieste, Italy; CIC 528, Herbert Pichler, Vienna, Austria; CIC 535, Peter Lang, Tuebingen, Germany; CIC 537, Maria del Mar Perera Alvarez and Maria Melania Moreno Vega, Las Palmas, Spain; CIC 538, Jaroslaw Dybko, Wroclaw, Poland; CIC 539, Mickey Koh and Sara Lozano Cerrada, London, United Kingdom; CIC 546, Goda Choi and Jaap van Doesum, Groningen, The Netherlands; CIC 561, Ioanna Sakellari, Thessaloniki, Greece; CIC 565, Gwendolyn van Gorkom, Maastricht, The Netherlands; CIC 576, Maria Jesus Pascual Cascon, Malaga, Spain; CIC 577, Teresa Zudaire, Pamplona, Spain; CIC 580, Khaled Halahleh, Amman, Jordan; CIC 583, Ilze Trociukas and Sara Krustina, Riga, Latvia; CIC 584, David Valcarcel, Barcelona, Spain; CIC 587, Massimo Martino, Reggio Calabria, Italy; CIC 589, Hakan Ozdogu, Adana Turkey; CIC 598, Carlos Manuel Panizo Santos and Maria Cruz Viguria Alegria, San Sebastian, Spain; CIC 599, Agnes Kelemen, Miskolc, Hungary; CIC 606, Nicola Mordini, Cuneo, Italy; CIC 607, Alessandra Picardi, Napoli, Italy; CIC 614, Nicolaus Kroeger and Dietlinde Janson, Hamburg, Germany; CIC 622, Ioannis Baltadakis, Athens, Greece; CIC 623, Cristina Tecchio, Verona, Italy; CIC 628, Filiz Vural, Izmir, Turkey; CIC 629, Tariq Ghafoor and Raheel Iftikhar, Rawalpindi, Pakistan; CIC 634, Gitte Olesen, Aarhus, Denmark; CIC 640, Matjaz Sever and Njetocka Gredelj, Ljubljana, Slovenia; CIC 650, Mathilde Hunault-Berger and Sylvie Francois, Angers, France; CIC 653, Jose Maria Fernandez Navarro, Valencia, Spain; CIC 656, Jan Vydra, Prague, Czech Republic; CIC 658, Alessandro Rambaldi, Bergamo, Italy; CIC 660, Francesco Merli and Luca Facchini, Reggio Emilia, Italy; CIC 663, Jaime Sanz Caballer and Pedro Chorao, Valencia Spain; CIC 670, Ronit Elhasid and Amit Dotan, Tel Aviv, Israel; CIC 671, Helene Labussiere-Wallet, Lyon, France; CIC 677, Grzegorz Helbig, Katowice, Poland; CIC 693, Kazimierz Halaburda and Barbara Nasilowska-Adamska, Warsaw, Poland; CIC 717, Jennifer Byrne, Nottingham, United Kingdom; CIC 732 Marta Gonzalez Vicent, Madrid, Spain; CIC 734, Antonio Perez-Martinez and Yasmina Mozo, Madrid, Spain; CIC 737, Jose Rifon, Pamplona, Spain; CIC 741, Fulvio Porta and Elena Soncini, Brescia, Italy; CIC 749, Lisa Pospiech and Jochen Casper, Oldenburg, Germany; CIC 755, Jerry Stein, Petach-Tikva, Israel; CIC 759, Alberto Mussetti, Barcelona, Spain; CIC 761, Muhlis Cem Ar and Tugrul Elverdi, Istanbul, Turkey; CIC 764, Jan Styczynski, Bydgoszcz, Poland; CIC 769, Jose Antonio Perez-Simon and Juan Alberto Martin Gonzalez, Sevilla, Spain; CIC 786, Eva Wagner-Drouet, Mainz, Germany; CIC 790, Arcangelo Prete, Bologna, Italy; CIC 795, Edoardo Benedetti and Ginevra Traverso, Pisa, Italy; CIC 799, Jan Zaucha and Agnieszka Piekarska, Gdansk, Poland; CIC 811, Giorgio La Nasa and Eugenia Piras, Cagliari, Italy; CIC 817, Krzysztof Kalwak and Jowita Fraczkiewicz, Wroclaw, Poland; CIC 824, Gergely Krivan and Csaba Kassa, Budapest, Hungary; CIC 825, Francesco Zallio, Alessandria, Italy; CIC 856, Amir Ali Hamidieh and Maryam Behfar, Teheran, Iran; CIC 859, Andriyana Bankova and Krasen Venkov, Sofia, Bulgaria; CIC 861, Michele Cimminiello, Potenza, Italy; CIC 868, Nicola Di Renzo and Vincenzo Federico, Lecce, Italy; CIC 911, Akif Yesilipek and Vedat Uygun, Antalya, Turkey; CIC 913, Musa Karakukcu, Kayseri, Turkey; CIC 919, Yener Koc, Istanbul, Turkey; CIC 926, Anne Sirvent and Jean-Jacques Tudesq, Montpellier, France; CIC 928, Carmine Selleri and Denise Morini and Bianca Serio, Salerno, Italy; CIC 933, Katharine Patrick, Sheffield, United Kingdom; CIC 981, Ali AlAhmari and Syed Jafri, Riyadh, Saudi Arabia; CIC 1001, Cigdem Ozturk, Muharraq Bahrain; CIC 1004, Ibrahim Eker, Afyonkarahisar, Turkey; CIC 1006, Marco Zecca, Pavia, Italy; CIC 1012, Jiong Hu, Shanghai, China; CIC 1032, Baodong Ye, Hangzhou China; CIC 1035, Galina Petrova, Moscow, Russia; CIC 1041, Sondus Alsharidah and Zoha Muneer Zubairi, Al-Sabah, Kuwait; CIC 1042, Juan Manual Herrera Parga and Oscar Ramirez, Cali, Colombia; CIC 1050, Andres Castaneda, Santiago and Hernan Lopez Vidal, Chile; CIC 1058, Rawad Rihani and Hasan Hashem, Amman, Jordan; CIC 1059, Mauricio Chaparro, Bogota, Colombia; CIC 1064, Rahul Bhargava and Neha Rastogi, Gurugram, India; CIC 1067, Fawaz Faddo, Baghdad, Iraq; CIC 1072, Hayder Alzughair and Ahmed Hamandi, Karbala, Iraq; CIC 1073, Jian Hou and Lijing Sheng, Shanghai, China; CIC 1074, Daihong Liu and Yao Sun, Beijing, China; CIC 1077, Dwi Wahyunianto Hadisantoso, Jakarta, Indonesia.

Author information

Authors and Affiliations

  1. Pediatric Oncology Hematology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy

    Simone Cesaro

  2. EBMT Study Unit, Leiden, Netherlands

    Inge Verheggen & Gloria Tridello

  3. Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus, University Torun, Bydgoszcz, Poland

    Jan Styczynski

  4. Radboud University Medical Center, Nijmegen, the Netherlands

    W. H. Mieke Roeven

  5. Kinghorn Cancer Centre, Sydney, Australia

    Angela Hwang

  6. Attikon University General Hospital, Athens, Greece

    Maria Stamouli

  7. Transplantation Department, Hematology Clinic, University Hospital St. Marina, Varna, Bulgaria

    Yavor Petrov

  8. National Center for Bone Marrow Transplant, Tunis, Tunisia

    Nour Ben Abdeljelil

  9. Department of Pediatric Oncology and Bone Marrow Transplantation, Hôpital Universitaire de Bruxelles, Hopital Universitaire des Enfants Reine Fabiola, Brussel, Belgium

    Pauline Mazilier

  10. Pediatric BMT Unit, Department of Bone Marrow Transplantation and Cancer Immunotherapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel

    Irina Zaidman

  11. Stem Cell Transplantation and Cell Therapy Unit, AORN Santobono Pausilipon, Naples, Italy

    Francesco Paolo Tambaro

  12. Department of Bone Marrow Transplantation and Cancer Immunotherapy, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Shlomo Elias

  13. Pediatric Stem Cell Transplant Unit, IRCCS San Gerardo dei Tintori, Monza, Italy

    Marta Verna

  14. Stem Cell Transplant Unit, Pediatric Cancer Center, Hospital Sant Joan de Deu Materno-Infantil, Barcelona, Spain

    Julia Marsal Ricoma

  15. Charles University Hospital, Prague, Czech Republic

    Michal Karas

  16. Hospital Clinico, Salamanca, Spain

    Lucia Lopez Corral

  17. St Sophia Children’s Hospital, Athens, Greece

    Evgenios Goussetis

  18. Hematology Department, Tor Vergata University, Rome, Italy

    Raffaella Cerretti

  19. Pediatric Hematology Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy

    Katia Perruccio

  20. University Hospital Ostrava, Ostrava, Czech Republic

    Michaela Hornakova

  21. Pediatric Blood and Marrow Transplantation Program, Children’s Hospital, University Hospital, Würzburg, Germany

    Matthias Wölfl

  22. Karolinska University Hospital, Stockholm, Sweden

    Anna Nordlander

  23. Pediatric Hematology, Oncology and Stem Cell Transplant Division, University Hospital, Padua, Italy

    Alessandra Biffi

  24. Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, Regina Margherita Children’s Hospital; Department of Pediatrics and Public Health Sciences, University of Turin, Turin, Italy

    Manuela Spadea

  25. Hospital Universitario Virgen de la Arrixaca, Murcia, Spain

    Andres Sanchez Salinas

  26. Humanitas Cancer Center, IRCCS Istituto Clinico Humanitas, Rozzano, Italy

    Stefania Bramanti

  27. Pediatric Hematology and Oncology Unit, University Hospital Gregorio Maranon, Faculty of Medicine Universidad Complutense, National Institute for Biomedical Research in Rare Diseases (CIBERER) Instituto de Salud Carlos III, Madrid, Spain

    Cristina Belendez

  28. Hematology Division, Ospedale Dell’Angelo, Venice, Italy

    Cristina Skert

  29. Department of Clinical Immunology and Transplantation, Jagiellonian University, Medical College, Transplantation Center, University Children’s, Krakow, Poland

    Jolanta Gozdzik

  30. Hematology Division, Stem Cell Transplant Program, Azienda Ospedaliero Universitaria, Modena, Italy

    Angela Cuoghi

  31. Universitari Germans Trias i Pujol, Badalona, Spain

    Maria Huguet Mas

  32. Hematology Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Martina Pennisi

  33. Hematology, Universitair Ziekenhuis, Brussel, Belgium

    Ann de Becker

  34. Hematology, Southampton General Hospital, Southampton, UK

    Deborah Richardson

  35. School of Medicine, University of Rijeka and University Hospital Centre, Rijeka, Croatia

    Zinaida Peric

  36. Hematology Division, Hospital de la Princesa, Madrid, Spain

    Rafael de la Camara

  37. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Dina Averbuch

  38. Pediatric Infectious Disease Unit, Hadassah Medical Center, Jerusalem, Israel

    Dina Averbuch

Authors
  1. Simone Cesaro
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  2. Inge Verheggen
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  3. Gloria Tridello
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  4. Jan Styczynski
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  5. W. H. Mieke Roeven
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  6. Angela Hwang
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  7. Maria Stamouli
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  8. Yavor Petrov
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  9. Nour Ben Abdeljelil
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  10. Pauline Mazilier
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  11. Irina Zaidman
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  12. Francesco Paolo Tambaro
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  13. Shlomo Elias
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  14. Marta Verna
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  15. Julia Marsal Ricoma
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  16. Michal Karas
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  17. Lucia Lopez Corral
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  18. Evgenios Goussetis
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  19. Raffaella Cerretti
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  20. Katia Perruccio
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  21. Michaela Hornakova
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  22. Matthias Wölfl
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  23. Anna Nordlander
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Contributions

SC designed and conducted the study; DA, ZP, RDLC, and JS, critically revised the design of the survey; IV collected the data; GT and SC analyzed the data; SC wrote the manuscript; SC, JS, WHMR, AH, MS, YP, NBA, PM, IZ, FPT, SE, MV, JMR, MK, LLC, EG, RC, KP, MH, MW, AN, AB, MS, ASS, SB, CB, CS, JG, AC, MHM, MP, AdB, DR, ZP, RDLC, and DA reported the data. All authors critically revised the manuscript and approved the final version of the manuscript.

Corresponding author

Correspondence to Simone Cesaro.

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Competing interests

SE received honoraria from Novartis and Gilead; MP received honoraria from Kite and Bristol Myers Squibb for participation in advisory boards; DA received speaker’s honoraria from MSD. All other authors declare no conflict of interest to disclose.

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Cesaro, S., Verheggen, I., Tridello, G. et al. A survey on the practices and the management of hemorrhagic cystitis in patients who undergo allogeneic hematopoietic stem cell transplantation, on behalf of the Infectious Diseases Working Party of EBMT. Bone Marrow Transplant (2025). https://doi.org/10.1038/s41409-025-02703-1

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  • DOI: https://doi.org/10.1038/s41409-025-02703-1

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