Hemorrhagic cystitis is a major complication of high-dose
cyclophosphamide therapy used in preparation for allogeneic or autologous
bone marrow transplantation. Although previous reports had suggested that the sulfhydryl-containing compound
mesna might be superior to forced diuresis in preventing
hemorrhagic cystitis, there were concerns about the effect of
mesna on engraftment in these studies. To address these concerns, 100 patients were randomized to receive
mesna or forced saline diuresis while undergoing bone marrow transplant conditioning with regimens that included high-dose
cyclophosphamide. To try to minimize the likelihood of graft rejection, patients who were being transplanted with
cyclophosphamide as a sole agent were excluded from the study. After randomization and administration of
therapy, patients were monitored by microscopic and dip-stick urinalyses; they were also followed for effects of
therapy on engraftment. The incidence of consistent or severe
hematuria was 33% in the
mesna arm and 20% in the
hyperhydration arm (P = .31). Severe
bleeding occurred in 12.5% of
mesna patients and 7.5% of
hyperhydration patients (P = .71). No unexpected toxicities were encountered, and engraftment times did not differ. Based on this randomized trial of 100 patients, we conclude that
mesna and
hyperhydration are equally effective in preventing
cyclophosphamide-induced
hemorrhagic cystitis in
bone marrow transplantation patients.