Among patients undergoing haploidentical allogeneic stem cell transplant (haplo-SCT) with post-transplant cytoxan prophylaxis (PtCy), reducing intravenous (IV) crystalloid fluid administration may decrease the risk of respiratory failure, according to research presented at the 2023 Tandem Transplantation and Cellular Therapy Meetings of ASTCT and CIBMTR. This link was not noted, however, in pediatric patients.

Treatment with IV crystalloid fluid administration to prevent hemorrhagic cystitis with high-dose cyclophosphamide has become more common during the COVID-19 pandemic.

In this quality improvement initiative, researchers aimed to determine whether reducing IV crystalloid fluid administration reduces the risk of respiratory failure among patients undergoing haplo-SCT.

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The researchers conducted a retrospective chart review; data were included for patients receiving PtCy after haplo-SCT between 2016 and 2022. Data were included for a pre-intervention (33 patients) and post-intervention group (10 patients); 12% and 70% of these patients, respectively, received cryopreserved haplo-SCT.

In the pre-intervention group, 45% of patients developed respiratory failure within 30 days after transplant; 93% of these patients had crystalloid fluid volume overload. A total of 30% of these patients required intensive care unit transfer, 39% had an acute kidney injury, and 18% required renal replacement therapy.

In the post-intervention group, the IV crystalloid fluid administration was reduced by approximately 15 L. In this group, no cases of intensive care unit transfer, acute kidney injury, or renal replacement therapy were noted.

“This single center quality improvement initiative shows that reducing IV crystalloid administration with PtCy is associated with a reduction in respiratory failure and other adverse clinical outcomes, without observed increase in hemorrhagic cystitis,” the authors noted. “Larger multi-center studies are needed to validate this finding.”


Lucchesi N, Young P, Mathone R, Volodin L, Ballen K, Varadarajan I. Impact of crystalloid administration on patients receiving haploidentical allogeneic stem cell transplant (haplo SCT) with post transplant cytoxan prophylaxis (PtCy) – a quality improvement initiative. Presented at: 2023 Tandem Transplantation and Cellular Therapy Meetings of ASTCT and CIBMTR; February 15-19, 2023. Abstract 179.