Renal insufficiency in patients with hematologic malignancies undergoing total body irradiation and bone marrow transplantation: a prospective assessment
Details
Serval ID
serval:BIB_ECA2B3897A0A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Renal insufficiency in patients with hematologic malignancies undergoing total body irradiation and bone marrow transplantation: a prospective assessment
Journal
International Journal of Radiation Oncology, Biology, Physics
ISSN
0360-3016
Publication state
Published
Issued date
03/2004
Peer-reviewed
Oui
Volume
58
Number
3
Pages
809-16
Notes
Journal Article
Multicenter Study --- Old month value: Mar 1
Multicenter Study --- Old month value: Mar 1
Abstract
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.
Keywords
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
Pubmed
Web of science
Create date
24/01/2008 18:16
Last modification date
20/08/2019 17:14