Intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation

C. Ippoliti, D. Przepiorka, R. Mehra, J. Neumann, J. Wood, D. Claxton, J. Gajewski, I. Khouri, K. Van Besien, B. Andersson, A. B. Deisseroth, C. P. Dinney

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Abstract

Objectives: To determine the minimal active dose and extent of activity of intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation. Methods: Twenty-four adults with grade 3 or 4 hemorrhagic cystitis were treated. All but 2 had failed other local therapy. Treatment was initiated at a median of 32 days post-transplant. Eleven patients received carboprost intravesicularly at 0.2 mg/dL for 60 minutes every 6 hours, and the dose was escalated every 24 hours until a dose of 1.0 mg/dL was reached unless a response was achieved. Thirteen additional patients were treated at an initial dose of 0.8 mg/dL, with escalation to 1.0 mg/dL after four doses in the absence of a response. Results: Overall, 15 of the 24 patients responded. In the dose-escalation setting, 0.8 mg/dL was the minimal active dose. The total response rate was 62% with doses at or above 0.8 mg/dL and 18% at lower doses. All but one response occurred with 7 or fewer days of therapy, and 9 patients relapsed later. Four additional patients were salvaged following cystoscopy with clot evacuation with or without alum or formalin instillation. In all but 1 patient, bladder spasms developed during treatment with carboprost, but were not sufficiently severe to discontinue therapy. Conclusions: Intravesicular carboprost at 1.0 mg/dL every 6 hours for no more than 7 days should be considered or a randomized study for treatment of refractory hemorrhagic cystitis. Cystoscopic examination and evacuation of clots prior to therapy may be required to achieve the full benefit of this treatment.

Original languageEnglish (US)
Pages (from-to)811-815
Number of pages5
JournalUrology
Volume46
Issue number6
DOIs
StatePublished - 1995
Externally publishedYes

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Carboprost
Cystitis
Transplantation
Bone Marrow
Therapeutics
Cystoscopy
Spasm
Formaldehyde
Urinary Bladder

ASJC Scopus subject areas

  • Urology

Cite this

Ippoliti, C., Przepiorka, D., Mehra, R., Neumann, J., Wood, J., Claxton, D., ... Dinney, C. P. (1995). Intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation. Urology, 46(6), 811-815. https://doi.org/10.1016/S0090-4295(99)80349-5

Intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation. / Ippoliti, C.; Przepiorka, D.; Mehra, R.; Neumann, J.; Wood, J.; Claxton, D.; Gajewski, J.; Khouri, I.; Van Besien, K.; Andersson, B.; Deisseroth, A. B.; Dinney, C. P.

In: Urology, Vol. 46, No. 6, 1995, p. 811-815.

Research output: Contribution to journalArticle

Ippoliti, C, Przepiorka, D, Mehra, R, Neumann, J, Wood, J, Claxton, D, Gajewski, J, Khouri, I, Van Besien, K, Andersson, B, Deisseroth, AB & Dinney, CP 1995, 'Intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation', Urology, vol. 46, no. 6, pp. 811-815. https://doi.org/10.1016/S0090-4295(99)80349-5
Ippoliti, C. ; Przepiorka, D. ; Mehra, R. ; Neumann, J. ; Wood, J. ; Claxton, D. ; Gajewski, J. ; Khouri, I. ; Van Besien, K. ; Andersson, B. ; Deisseroth, A. B. ; Dinney, C. P. / Intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation. In: Urology. 1995 ; Vol. 46, No. 6. pp. 811-815.
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abstract = "Objectives: To determine the minimal active dose and extent of activity of intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation. Methods: Twenty-four adults with grade 3 or 4 hemorrhagic cystitis were treated. All but 2 had failed other local therapy. Treatment was initiated at a median of 32 days post-transplant. Eleven patients received carboprost intravesicularly at 0.2 mg/dL for 60 minutes every 6 hours, and the dose was escalated every 24 hours until a dose of 1.0 mg/dL was reached unless a response was achieved. Thirteen additional patients were treated at an initial dose of 0.8 mg/dL, with escalation to 1.0 mg/dL after four doses in the absence of a response. Results: Overall, 15 of the 24 patients responded. In the dose-escalation setting, 0.8 mg/dL was the minimal active dose. The total response rate was 62{\%} with doses at or above 0.8 mg/dL and 18{\%} at lower doses. All but one response occurred with 7 or fewer days of therapy, and 9 patients relapsed later. Four additional patients were salvaged following cystoscopy with clot evacuation with or without alum or formalin instillation. In all but 1 patient, bladder spasms developed during treatment with carboprost, but were not sufficiently severe to discontinue therapy. Conclusions: Intravesicular carboprost at 1.0 mg/dL every 6 hours for no more than 7 days should be considered or a randomized study for treatment of refractory hemorrhagic cystitis. Cystoscopic examination and evacuation of clots prior to therapy may be required to achieve the full benefit of this treatment.",
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T1 - Intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation

AU - Ippoliti, C.

AU - Przepiorka, D.

AU - Mehra, R.

AU - Neumann, J.

AU - Wood, J.

AU - Claxton, D.

AU - Gajewski, J.

AU - Khouri, I.

AU - Van Besien, K.

AU - Andersson, B.

AU - Deisseroth, A. B.

AU - Dinney, C. P.

PY - 1995

Y1 - 1995

N2 - Objectives: To determine the minimal active dose and extent of activity of intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation. Methods: Twenty-four adults with grade 3 or 4 hemorrhagic cystitis were treated. All but 2 had failed other local therapy. Treatment was initiated at a median of 32 days post-transplant. Eleven patients received carboprost intravesicularly at 0.2 mg/dL for 60 minutes every 6 hours, and the dose was escalated every 24 hours until a dose of 1.0 mg/dL was reached unless a response was achieved. Thirteen additional patients were treated at an initial dose of 0.8 mg/dL, with escalation to 1.0 mg/dL after four doses in the absence of a response. Results: Overall, 15 of the 24 patients responded. In the dose-escalation setting, 0.8 mg/dL was the minimal active dose. The total response rate was 62% with doses at or above 0.8 mg/dL and 18% at lower doses. All but one response occurred with 7 or fewer days of therapy, and 9 patients relapsed later. Four additional patients were salvaged following cystoscopy with clot evacuation with or without alum or formalin instillation. In all but 1 patient, bladder spasms developed during treatment with carboprost, but were not sufficiently severe to discontinue therapy. Conclusions: Intravesicular carboprost at 1.0 mg/dL every 6 hours for no more than 7 days should be considered or a randomized study for treatment of refractory hemorrhagic cystitis. Cystoscopic examination and evacuation of clots prior to therapy may be required to achieve the full benefit of this treatment.

AB - Objectives: To determine the minimal active dose and extent of activity of intravesicular carboprost for the treatment of hemorrhagic cystitis after marrow transplantation. Methods: Twenty-four adults with grade 3 or 4 hemorrhagic cystitis were treated. All but 2 had failed other local therapy. Treatment was initiated at a median of 32 days post-transplant. Eleven patients received carboprost intravesicularly at 0.2 mg/dL for 60 minutes every 6 hours, and the dose was escalated every 24 hours until a dose of 1.0 mg/dL was reached unless a response was achieved. Thirteen additional patients were treated at an initial dose of 0.8 mg/dL, with escalation to 1.0 mg/dL after four doses in the absence of a response. Results: Overall, 15 of the 24 patients responded. In the dose-escalation setting, 0.8 mg/dL was the minimal active dose. The total response rate was 62% with doses at or above 0.8 mg/dL and 18% at lower doses. All but one response occurred with 7 or fewer days of therapy, and 9 patients relapsed later. Four additional patients were salvaged following cystoscopy with clot evacuation with or without alum or formalin instillation. In all but 1 patient, bladder spasms developed during treatment with carboprost, but were not sufficiently severe to discontinue therapy. Conclusions: Intravesicular carboprost at 1.0 mg/dL every 6 hours for no more than 7 days should be considered or a randomized study for treatment of refractory hemorrhagic cystitis. Cystoscopic examination and evacuation of clots prior to therapy may be required to achieve the full benefit of this treatment.

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