Renal insufficiency in patients with hematologic malignancies undergoing total body irradiation and bone marrow transplantation: a prospective assessment


Serval ID
Article: article from journal or magazin.
Renal insufficiency in patients with hematologic malignancies undergoing total body irradiation and bone marrow transplantation: a prospective assessment
International Journal of Radiation Oncology, Biology, Physics
Miralbell  R., Sancho  G., Bieri  S., Carrio  I., Helg  C., Brunet  S., Martin  P. Y., Sureda  A., Gomez De Segura  G., Chapuis  B., Estorch  M., Ozsahin  M., Keller  A.
Publication state
Issued date
Journal Article
Multicenter Study --- Old month value: Mar 1
PURPOSE: Patients with malignant hematologic disorders undergoing bone marrow transplantation (BMT) may develop renal insufficiency. A study was undertaken to assess prospectively the subclinical renal function changes with radioisotopic methods in patients undergoing BMT for hematologic malignancies. METHODS AND MATERIALS: We studied 71 patients with normal renal function undergoing BMT for various hematologic malignancies, mostly leukemias. Conditioning included chemotherapy and 12 Gy (45 patients) or 13.5 Gy (26 patients) fractionated total-body irradiation (TBI). In 21 patients receiving 12 Gy TBI, the kidney dose was limited to 10 Gy using partial transmission blocks fabricated after renal opacification with nonionic, hypo-osmolar contrast medium. The glomerular filtration rate (GFR) and effective renal plasmatic flow (ERPF) were determined radioisotopically before conditioning and at 4, 12, and 18 months, using (51)Cr ethylene-diamine-tetra-acetic acid and (131)I ortho-iodo-hippurate, respectively. Renal insufficiency was defined as a decrease of >/=30% in GFR or ERPF compared with the baseline values. The potential influence of patient- and treatment-related variables on renal dysfunction was assessed. RESULTS: At 4 (early) and 12-18 (late) months, a >/=30% GFR drop was observed in 54% and 49% of patients and a >/=30% ERPF drop in 44% and 34% of patients, respectively. After stepwise logistic analysis, a GFR reduction at 4 months correlated significantly with age (<40 years old, worse), TBI using kidney blocks (partial kidney shielding to 10 Gy was associated with a higher rate of renal dysfunction at 4 months compared with the full TBI dose), and days of aminoglycoside/vancomycin use. An ERPF drop at 4 months was independently related with the days of amphotericin use and days of prostaglandin E(1) use (prophylaxis against hepatic venoocclusive disease). A GFR and ERPF reduction at 12-18 months correlated with days of amphotericin use and days of prostaglandin E(1) use, respectively. CONCLUSION: Early post-BMT renal dysfunction is associated with the administration of potentially nephrotoxic drugs. An inverse correlation with the prescribed TBI dose was observed; patients whose kidneys received 10 Gy through the use of partial shielding blocks had significantly greater renal dysfunction at 4 months. The administration of potentially nephrotoxic contrast agents used in radiotherapy treatment planning may be responsible for the latter observation. Prostaglandin E(1) use correlated with a significant reduction in ERPF at both 4 and 12-18 months.
Adolescent Adult Bone Marrow Transplantation/*adverse effects Dose Fractionation Edetic Acid/diagnostic use Female *Glomerular Filtration Rate/drug effects/physiology/radiation effects Hematologic Neoplasms/therapy Humans Immunosuppressive Agents/adverse effects Iodine Radioisotopes/therapeutic use Iodohippuric Acid/diagnostic use Kidney/*blood supply/drug effects/radiation effects Kidney Failure, Chronic/*etiology Logistic Models Male Middle Aged Prospective Studies Regional Blood Flow/drug effects/radiation effects Transplantation Conditioning/adverse effects/methods Whole-Body Irradiation
Web of science
Create date
24/01/2008 18:16
Last modification date
20/08/2019 17:14
Usage data