Review Question - QID 101429

This patient is most likely suffering from hemorrhagic cystitis secondary to cyclophosphamide administration. Hemorrhagic cystitis is a result bladder damage by a toxic metabolite of cyclophosphamide (acrolein). Hemorrhagic cystitis due to cyclophosphamide administration can be prevented with administration of mesna.

Cyclophosphamide is a chemotherapeutic drug that covalently crosslinks DNA at the guanine N7 position. It is used for the treatment of non-Hodgkin's lymphoma, breast cancer, ovarian cancer, and as an immunosuppressant. Its well-known side effects include hemorrhagic cystitis and myelosuppression.

Seehusen et al. report the late effects of cyclophosphamide therapy in the treatment of childhood cancers to include hemorrhagic cystitis, bladder fibrosis, dysfunctional voiding, neurogenic bladder, and even bladder malignancy.

deVries reviews the causes of hemorrhagic cystitis: acute, fulminant bladder hemorrhage usually is seen at tertiary care centers in which cancer patients are treated with alkylating agents, particularly cyclophosphamide and isophosphamide. These agents are also used to treat other conditions, such as lupus erythematosis and Wegener's granulomatosis. Other iatrogenic causes of bleeding include treatment with penicillins.

Illustration A displays a pathological specimen of bladder affected by hemorrhagic cystitis.

Incorrect answers:
Answer 2: Cisplatin does not cause hemorrhagic cystitis but instead may cause renal damage and hearing loss.
Answer 3: Administration of mesna can prevent hemorrhagic cystitis in a patient undergoing treatment with cyclophosphamide.
Answer 4: The side effect most commonly associated with bleomycin is pulmonary fibrosis, not hemorrhagic cystitis.
Answer 5: Carmustine is a DNA-alkylating agent in the nitrosourea class used for the treatment of brain tumors.