Bone Marrow Transplantation (2006) 38, 707 & 2006 Nature Publishing Group All rights reserved 0268-3369/06 $30.00
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LETTER TO THE EDITOR
Acute renal failure following myeloablative autologous and allogeneic hematopoietic cell transplantation Bone Marrow Transplantation (2006) 38, 707. doi:10.1038/sj.bmt.1705513; published online 2 October 2006 The incidence of acute renal failure (ARF) in the early period of myeloablative hematopoietic cell transplantation (HCT) varies from 30 to 90%, and is higher in patients receiving an allogeneic HCT.1–5 We sought to evaluate retrospectively the incidence of ARF, defined as a doubling of serum creatinine within the first 100 days after HCT, risk factors, therapy as well as outcome of HCT patients who received a myeloablative autologous or allogeneic HCT in our hospital between January 2003 and December 2004. One hundred and forty patients (86 men, mean age: 32.9714.69 years) were studied: 90 patients had an allogeneic HCT and 50 patients had an autologous HCT; 82 patients received a peripheral blood stem cell (PBSC) transplantation and 58 patients received a bone marrow (BM) graft. In allogeneic HCT patients, the conditioning regimen consisted of busulfan/cyclophosphamide or busulfan/cyclophosphamide combined with etoposide or melphalan in patients with advanced disease, whereas in autologous HCT patients the conditioning regimen consisted of BCNU/etoposide/cytosine-arabinoside/melphalan for lymphomas, melphalan for multiple myeloma and etoposide/melphalan/carboplatin for solid tumors. All patients received prostaglandin E1 0.5 mg/day by continuous infusion as prophylaxis for hepatic veno-occlusive disease. Patients did not differ in terms of age, sex and comorbidity, namely cardiovascular disease, diabetes mellitus or prior chronic kidney disease. The incidence of ARF was 21.5%, but did not reach a statistically significant difference between patients receiving an allogeneic or autologous HCT (27 vs 12%, P ¼ 0.07) or transplanted with BM graft or PBSC (10 vs 17%, P ¼ NS). Nephrotoxicity (n ¼ 20), septic shock (n ¼ 16), graft-vs-host disease (n ¼ 6) and hepatic veno-occlusive disease (n ¼ 3) were the most common associated etiologies. The incidence of dialysis-dependent ARF was 30%, and was higher in patients with a BM graft (50 vs 7%, Po0.03) and more frequent in allogeneic HCT, although not statistically
different (33 vs 16%, P ¼ 0.08); nine patients received renal replacement therapy: four patients were treated with intermittent hemodialysis and five patients with continuous veno-venous hemodiafiltration. Overall mortality rate was 16.4%, and was higher in patients with ARF (57 vs 6%, P ¼ 0.0001), particularly if there was a need of renal replacement therapy (100 vs 38%, P ¼ 0.006). We demonstrate that ARF is prevalent during the early period of HCT and increases mortality, particularly if dialysis-dependent. However, in our cohort overall incidence of ARF was lower than the previously described,1–5 and low occurrence of veno-occlusive disease, probably related to adequate prophylactic measures, could be implied. JA Lopes1, S Jorge1, S Silva1, E de Almeida1, F Abreu1, C Martins2, JA do Carmo2, JF Lacerda2 and MM Prata1 1 Department of Nephrology and Renal Transplantation, Hospital de Santa Maria, Lisboa, Portugal and 2 Department of Hematology, Hospital de Santa Maria, Lisboa, Portugal E-mail:
[email protected]
References 1 Noel C, Hazzan M, Noel-Walter MP, Jouet JP. Renal failure and bone marrow transplantation. Nephrol Dial Transplant 1998; 13: 2464–2466. 2 Parikh CR, McSweeney PA, Korular D, Ecder T, Merouani A, Taylor J et al. Renal dysfunction in allogeneic hematopoietic cell transplantation. Kidney Int 2002; 62: 566–573. 3 Parikh CR, Schrier RW, Storer B, Diaconescu R, Sorror ML, Maris MB et al. Comparison of ARF after myeloablative and non-myeloablative hematopoietic cell transplantation. Am J Kidney Dis 2005; 45: 502–509. 4 Parikh CR, McSweeney P, Schrier RW. Acute renal failure independently predicts mortality after myeloablative allogeneic and hematopoietic cell transplantation. Kidney Int 2005; 67: 1999–2005. 5 Caliskan Y, Besisik SK, Sargin D, Ecder T. Early renal injury after myeloablative allogeneic and autologous hematopoietic cell transplantation. Bone Marrow Transplant 2006; 38: 141–147.
