Cyclophosphamide and Haemorrhagic Cystitis

The case is presented of a woman, aged 39 years, with malignant lymphoma, who developed hæmorrhagic cystitis after treatment with a total of 6.5 gm of cyclophosphamide over a 10-week period. Cyclophosphamide is unique amongst chemotherapeutic agents in causing this complication. Bleeding is usually mild, but may be severe and necessitate transfusion and ureteric diversion. Adequate hydration prevents severe reactions. A discussion of postulated mechanisms and known histopathological effects is given.