Table 2. MESNA with Hydration Evidence.

First Author, Year Study Design	Subjects	Findings	GRADE quality level
Hows, 1984 RCT	61 SCT adult patients	Mesna plus 3 liters of IV hydration daily during CTX is more effective for HC than 6 liters of IV hydration plus diuresis (p<0.05)	Moderate
Shepard, 1991 RCT	100 adult patients with cancer	No difference between mesna plus 1.5 liters/m2/day of IV fluids compared to 3 liters/m2/day of IV fluids plus lasix for severe HC (p=0.71)	High
Khojasteh, 2000 Case study	18 pediatric and young adults with leukemia or hematological disease	Adding mesna with IV fluids at 3 liters/m2/day is effective in preventing HC	Low
Murphy, 1993 Retrospective	217 adult patients with cancer	No HC prevalence difference between IV hydration at 3.6 liters/m2/day compared to same IV hydration plus mesna	Moderate
Marshall, 2011 Case study	1 adult patient with breast cancer	CTX without hydration caused HC but mesna plus IV hydration given with subsequent CTX with no HC	Very Low
Monarch, 2010 Systematic review	38 articles	No HC prevalence difference between IV hydration at 3 liters/m2/day compared to IV hydration of 1.5-3 liters/day plus mesna	Moderate
Schuchter, 2002 Clinical guideline		Update of the 1999 chemotherapy and radiotherapy protectants clinical guideline by ASCO; mesna plus saline diuresis or forced saline diuresis is recommended for high dose CTX	Not applicable
Damron, 2009 Systematic Review	54 articles	Mesna plus saline diuresis or forced diuresis with high dose CTX	High

Abbreviations: RCT = randomized control trial; SCT = stem cell transplant; IV = intravenous; CTX = Cytoxan; HC = hemorrhagic cystitis; ASCO = American Society of Clinical Oncology