AbstractIntroduction: Hemorrhagic cystitis (HC) is a common complication after allogeneic hematopoietic stem cell transplantation (HSCT), characterized by inflammation and bleeding of the bladder. Hyperbaric oxygen therapy (HBOT) has been shown to be effective in the treatment of radiation-induced HC.

摘要简介：出血性膀胱炎（HC）是异基因造血干细胞移植（HSCT）后的常见并发症，其特征是膀胱炎症和出血。高压氧治疗（HBOT）已被证明可有效治疗辐射诱发的HC。

However, the optimal treatment for HC after allogeneic HSCT has not yet been established. Furthermore, limited research has been conducted on the use of HBOT in this setting. This study aimed to evaluate the effectiveness and safety of HBOT in patients with late-onset HC after allogeneic HSCT. Methods: Twenty-five-year (1998–2022) retrospective analysis performed in all consecutive patients with confirmed late-onset HC after allogeneic HSCT treated with HBOT at two centers in Portugal.

然而，同种异体HSCT后HC的最佳治疗方法尚未确定。此外，在这种情况下，对HBOT的使用进行了有限的研究。本研究旨在评估HBOT治疗异基因造血干细胞移植后迟发性HC患者的有效性和安全性。方法：对葡萄牙两个中心接受HBOT治疗的同种异体HSCT后确诊为迟发性HC的所有连续患者进行了25年（1998-2022）的回顾性分析。

Medical records were reviewed for clinical and laboratory features, primary indications for allogeneic HSCT, conditioning regimen, and treatment strategies for HC. Patients received 100% oxygen at 2.1–2.5 atmosphere absolute pressure (ATA) for 70–90-minute periods, once daily, five times per week. Complete clinical response was defined as the absence of macroscopic hematuria sustained for at least 2 weeks, and partial response was described as a downgrading in the severity of HC.

回顾了医疗记录的临床和实验室特征，同种异体HSCT的主要适应症，预处理方案和HC的治疗策略。患者在2.1-2.5大气压绝对压力（ATA）下接受100%氧气，持续70-90分钟，每天一次，每周五次。完全临床反应被定义为持续至少2周没有肉眼血尿，部分反应被描述为HC严重程度的下降。

Statistical significance was considered for values of p < 0.05. Results: The sample included 61 patients with a mean age of 28.0 (SD 14.2) years, 33 males. Complete response was achieved in 72.1% (n = 44) of patients and partial response in 14.8% (n = 9). Concerning patients with a complete response, the median number of HBOT sessions was 15.5 sessions (IQR 10.0-26.8).

统计学显着性被认为是p<0.05的值。结果：样本包括61名患者，平均年龄28.0（SD 14.2）岁，男性33名。72.1%（n=44）的患者完全缓解，14.8%（n=9）的患者部分缓解。对于完全缓解的患者，HBOT治疗的中位数为15.5次（IQR 10.0-26.8）。

Patients treated with 10 or more sessions of HBOT had a higher rate of complete or partial response (OR 12.5, 95%CI 1.9–83.2, p-value < 0.05). There .

接受10次或10次以上HBOT治疗的患者完全或部分缓解率较高（or 12.5，95%CI 1.9-83.2，p值<0.05）。在那里。

IntroductionAllogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for many malignant and non-malignant hematologic conditions. Hemorrhagic cystitis (HC) is a syndrome characterized by hematuria and symptoms of urinary tract irritability1. It is an important cause of morbidity in patients undergoing allogeneic HSCT, leading to prolonged hospitalization, reduced quality of life, and increased healthcare costs2,3.

。出血性膀胱炎（HC）是一种以血尿和尿路烦躁症状为特征的综合征1。这是异基因造血干细胞移植患者发病的重要原因，导致住院时间延长，生活质量下降，医疗费用增加2,3。

However, the increase in post-allogeneic HSCT morbidity and mortality associated with hemorrhagic cystitis is controversial, highlighting the complex nature of this condition. The variability in data can be attributed to multiple factors, including disparities in patient selection, underlying clinical conditions, and several treatment protocols that can influence outcomes.

然而，与出血性膀胱炎相关的异基因造血干细胞移植后发病率和死亡率的增加是有争议的，突出了这种情况的复杂性。数据的可变性可归因于多种因素，包括患者选择的差异，潜在的临床状况以及可能影响结果的几种治疗方案。

Moreover, accurate mortality assessment is further complicated by the interaction of different risk factors, such as graft source, graft-versus-host disease (GvHD), and the development of opportunistic infections. These factors vary significantly among patient cohorts, making it challenging to establish a direct causal relationship between HC and increased morbidity and mortality3.The classification of HC is based on its onset after HSCT and is divided into early-onset and late-onset HC, reflecting different physiopathology.

。这些因素在患者队列中差异很大，因此难以建立HC与发病率和死亡率增加之间的直接因果关系3。HC的分类基于HSCT后的发病，分为早发性和迟发性HC，反映了不同的生理病理学。

Early-onset HC occurs within the first week after HSCT, typically within 48 h after conditioning3. It results from the direct toxicity of the conditioning regimen on the urothelial mucosa, particularly from alkylating agents (cyclophosphamide, ifosfamide, busulfan) and total body irradiation. It is aggravated by concurrent thrombocytopenia and coagulation abnormalities3,4.Late-onset HC can be observed up to the first 6 months after HS.

早期发作的HC发生在HSCT后的第一周内，通常在调理后48小时内3。它是由预处理方案对尿路上皮粘膜的直接毒性引起的，特别是烷化剂（环磷酰胺，异环磷酰胺，白消安）和全身照射。并发血小板减少症和凝血异常会加重病情3,4。HS后6个月可观察到迟发性HC。

Data availability

数据可用性

The datasets generated and/or analyzed during the current study are not publicly available due ethical or legal restrictions but are available from the corresponding author on reasonable request.

。

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Download referencesAcknowledgementsWe would like to acknowledge our partner, CUF Oncology, for all the support.Author informationAuthors and AffiliationsPulmonology Department, Unidade Local de Saúde da Guarda, E. P. E., Avenida Rainha Dona Amélia 19, Guarda, 6300-749, PortugalJoana Arana RibeiroMedical Oncology Department, Hospital de Cascais, Alcabideche, Cascais, PortugalDiogo Alpuim CostaHematology and Oncology Department, CUF Oncologia, Lisbon, PortugalDiogo Alpuim CostaCentro Hiperbárico de Cascais, Lisbon, PortugalDiogo Alpuim CostaNOVA Medical School I Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, PortugalDiogo Alpuim CostaFaculdade de Medicina da Universidade de Lisboa, Lisbon, PortugalDiogo Alpuim CostaAnesthesiology Department, Unidade Local de Saúde de Matosinhos, E.

下载参考资料致谢我们感谢我们的合作伙伴CUF Oncology提供的所有支持。作者信息作者和所属机构：葡萄牙国立萨瓦达瓜尔达地方大学肺科，Avenida Rainha Dona Amélia 19，Guarda，6300-749，葡萄牙Joana Arana Ribeiro，Cascais医院，Alcabideche，Cascais，葡萄牙Diogo Alpuim海岸血液学和肿瘤学系，CUF肿瘤学，里斯本，葡萄牙DioGo Alpuim Costa Centro Hiperbárico de Cascais，里斯本，新大学，葡萄牙Diogo-Alpim CostaNOVA医学院I Faculdade de Ciencias Médicas里斯本，里斯本，葡萄牙Diogo Alpuim Costa里斯本大学医学院，里斯本，里斯本

P. E, Porto, PortugalClara Gaio-Lima, Inês Portugal Rodrigues & Óscar CamachoUnidade de Medicina Hiperbárica (UHM), Unidade Local de Saúde de Matosinhos, E. P. E, Porto, PortugalClara Gaio-Lima & Óscar CamachoMedical Oncology Department, Hospital Garcia de Orta, E. P. E, Almada, PortugalJosé Guilherme Gonçalves-NobreInstituto de Saúde Ambiental (ISAMB), Faculdade de Medicina da Universidade de Lisboa, Lisbon, PortugalJosé Guilherme Gonçalves-NobreInstituto de Medicina Preventiva & Saúde Pública (IMP&SP), Faculdade de Medicina da Universidade de Lisboa, Lisboa, PortugalJosé Guilherme Gonçalves-NobreHematology Department, Centro Hospitalar Tondela Viseu, E.

P.E，波尔图，葡萄牙卡拉·盖奥·利马，Inês Portugal Rodrigues&Óscar Camacho Hyperbarica医学联合会（UHM），Saúde de Matosinhos地方联合会，E.P.E，Porto，葡萄牙卡拉·盖奥·利马&Óska Camacho Garcia de Orta医院肿瘤内科，E.P.E.，Almada，葡萄牙JoséGuilherme Gonçalves Nobre环境研究所预防医学和公共卫生部（IMP&SP），里斯本大学医学院，里斯本，葡萄牙JoséGuilherme Gonçalves Nobre血液科，Tondela Viseu中心医院，E。

P. E, Viseu, PortugalMariana Trigo MirandaBone Marrow Transplantation Unit, Instituto Português de Oncologia do Porto Francisco Gentil, E. P. E, Porto, PortugalCarlos Pinho VazCentro de Medicina Subaquática e Hiperbárica (CMSH), Hospital das Forças Armadas, Lisbon, PortugalCarla D’Espiney AmaroAuthorsJoana .

P.E，Viseu，葡萄牙马里纳·特里戈·米兰达骨髓移植科，波尔图弗朗西斯科·詹蒂尔葡萄牙肿瘤学研究所，E.P.E，波尔图，葡萄牙Carlo Pinho Vaz水下和嬉皮士医学中心（CMSH），里斯本Forças Armadas医院，葡萄牙Carlo D'Espney AmaroAuthorsJoana。

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PubMed Google ScholarContributionsThe present manuscript is the result of original work by the authors. Conception and design: Arana Ribeiro J, Alpuim Costa D, Gaio-Lima C. Acquisition, analysis and interpretation of data: Arana Ribeiro J, Alpuim Costa D, Gaio-Lima C, Rodrigues Portugal I, Trigo M.

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Writing, review, and/or revision of the manuscript: Arana Ribeiro J, Alpuim Costa D, Gaio-Lima C, Guilherme Nobre J, Rodrigues Portugal I, Trigo M. Manuscript supervision: Alpuim Costa D, Pinho Vaz C, Espiney Amaro C, Camacho O.Corresponding authorCorrespondence to.

手稿的撰写，审查和/或修订：Arana Ribeiro J，Alpuim Costa D，Gaio Lima C，Guilherme Nobre J，Rodrigues Portugal I，Trigo M.手稿监督：Alpuim Costa D，Pinho Vaz C，Espiney Amaro C，Camacho O.通讯作者回复。

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Reprints and permissionsAbout this articleCite this articleArana Ribeiro, J., Alpuim Costa, D., Gaio-Lima, C. et al. Hyperbaric oxygen therapy in the treatment of late-onset hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation.

转载和许可本文引用本文Arana Ribeiro，J.，Alpuim Costa，D.，Gaio Lima，C。等人。高压氧疗法治疗异基因造血干细胞移植后迟发性出血性膀胱炎。

Sci Rep 14, 24658 (2024). https://doi.org/10.1038/s41598-024-74858-8Download citationReceived: 20 August 2023Accepted: 30 September 2024Published: 21 October 2024DOI: https://doi.org/10.1038/s41598-024-74858-8Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

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