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ORIGINAL RESEARCH article

Front. Immunol.

Sec. Alloimmunity and Transplantation

Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1543099

This article is part of the Research Topic PTCY and Allo-HCT: A Deep Dive into Outcomes, Toxicities, and Patient-Centered Care View all articles

Impact of Hyperhydration on Fluid Overload (FO) and Hematopoietic Cell Transplant (HCT) after Post-Transplant Cyclophosphamide (PTCy)-based Graft-versus-Host-Disease (GvHD) Prophylaxis

Provisionally accepted
Diana T Samuels Diana T Samuels 1Janny M. Yao Janny M. Yao 1Yazeed Samara Yazeed Samara 2Dongyun Yang Dongyun Yang 3Sally Mokhtari Sally Mokhtari 4Katrin Tiemann Katrin Tiemann 4Salman Otoukesh Salman Otoukesh 2Shukaib Arslan Shukaib Arslan 2Hoda Pourhassan Hoda Pourhassan 2Stephanie Wu Stephanie Wu 5Amanda Blackmon Amanda Blackmon 2Vaibhav Agrawal Vaibhav Agrawal 2Idoroenyi Amanam Idoroenyi Amanam 2Haris Ali Haris Ali 2Amandeep Salhotra Amandeep Salhotra 2Ibrahim Aldoss Ibrahim Aldoss 2Brian Ball Brian Ball 2Paul Koller Paul Koller 2Ahmed Aribi Ahmed Aribi 2Karamjeet Sandhu Karamjeet Sandhu 2Vinod Pullarkat Vinod Pullarkat 2Andrew Artz Andrew Artz 2Eileen Smith Eileen Smith 2Forrest Stewart Forrest Stewart 2Pamela Becker Pamela Becker 2Anthony Stein Anthony Stein 2Guido Marcucci Guido Marcucci 2Stephen J Forman Stephen J Forman 2Ryotaro Nakamura Ryotaro Nakamura 2Monzr M. Al Malki Monzr M. Al Malki 2*
  • 1 Department of Pharmacy, City of Hope National Medical Center, Duarte, California, United States
  • 2 Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, United States
  • 3 Department of Computation and Quantitative Medicine, City of Hope National Medical Center, Duarte, California, United States
  • 4 City of Hope Department of Clinical and Translational Project Development, Duarte, United States
  • 5 Department of Internal Medicine, City of Hope National Medical Center, Duarte, United States

The final, formatted version of the article will be published soon.

    Introduction: Hemorrhagic cystitis (HC) is an early complication after hematopoietic cell transplant (HCT) with post-transplant cyclophosphamide (PTCy). Hyperhydration can reduce HC, but may lead to fluid overload (FO), which has been associated with higher non-relapse mortality (NRM) after HCT.Methods: The objectives of this study were to grade FO between days 3 and 8 based on weight gain, diuretic therapy, and FO-related organ dysfunction and analyze the impact of FO on non-relapse mortality (NRM) and subsequently on overall survival (OS) of patients undergoing HCT with PTCybased GvHD prophylaxis.Results: Two hundred seventy-five patients who received PTCy at City of Hope from 2009 to 2018 were included. A majority, 270 (98%) patients were diagnosed with early FO from day 3-8 post HCT, of whom 248 (92%) experienced mild to moderate (grade 1-2) FO, and 22 (8%) experienced severe (grade 3-4) FO. Day 100 NRM was significantly higher in patients with grade 3-4 FO compared to patients with grade 0-1 (59.1 vs 1.7%, CI: 0.006-0.053p<0.001) and grade 2 (59.1 vs 8.8%, CI: 0.043-0.178, p<0.001) FO. At 2 years, OS and DFS were significantly lower in patients who experienced grade 3-4 FO compared to patients who had grade 0-1 FO (31.8% vs 68.2%, CI: 0.616-0.755, p<0.001) and grade 2 FO (31.8% vs 62.5%; CI: 0.527-0.741, p<0.001). Additionally, each 5% weight gain from baseline was associated with higher NRM (HR=1.91, 95%CI: 1.64-2.23, p<0.001).Conclusion: Almost all patients undergoing hyperhydration for PTCy-induced HC will present with FO. Grade 3-4 FO is uncommon and associated with poor clinical outcomes. Weight gain could be used as an early and possibly modifiable indicator of FO

    Keywords: Allogeneic hematopoietic cell transplantation, post-transplant cyclophosphamide, Hyperhydration, hemorrhagic cystitis, fluid overload, fluid retention, Fluid toxicity, Weight Gain

    Received: 10 Dec 2024; Accepted: 03 Feb 2025.

    Copyright: © 2025 Samuels, Yao, Samara, Yang, Mokhtari, Tiemann, Otoukesh, Arslan, Pourhassan, Wu, Blackmon, Agrawal, Amanam, Ali, Salhotra, Aldoss, Ball, Koller, Aribi, Sandhu, Pullarkat, Artz, Smith, Stewart, Becker, Stein, Marcucci, Forman, Nakamura and Al Malki. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Monzr M. Al Malki, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, 91010, California, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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