Tarbell N J, Guinan E C, Chin L, Mauch P, Weinstein H J
Department of Radiation Therapy, Harvard Medical School, Boston, MA.
Radiother Oncol. 1990;18 Suppl 1:139-42. doi: 10.1016/0167-8140(90)90195-3.
Between 1980 and 1987, 59 children with acute lymphoblastic leukemia (ALL) or stage IV neuroblastoma (NB) underwent allogeneic or autologous bone marrow transplantation (BMT). Thirty-nine of these patients were alive and in remission 6 months post BMT and were evaluable for this analysis. Sixteen have developed renal dysfunction. Eight were transplanted for relapsed ALL and received an autologous transplant. Preparation included tenopiside (VM 26), cytosine arabinoside, and cyclophosphamide followed by total body irradiation (TBI). One patient received 850 cGy in a single fraction, while all other patients received fractionated TBI (1200-1400 cGy in 6-8 fractions over 3-4 days). Eight of 11 evaluable patients who received a BMT for NB have developed late renal problems (4-7 months after BMT). The preparation for neuroblastoma patients included VM 26, cis-platinum, melphalan, cyclophosphamide and fractionated TBI (1200-1296 cGy). All 8 neuroblastoma patients had received cis-platinum as induction treatment prior to transplantation. All patients presented with anemia, hematuria and elevations of BUN and creatinine. Renal biopsies were consistent with radiation nephropathy. In conclusion, a high incidence of renal dysfunction has occurred after BMT in children with neuroblastoma and ALL. The clinical and laboratory features are consistent with either radiation nephropathy or hemolytic-uremic syndrome. The relatively young age of these patients and conditioning with intensive multi-agent chemotherapy may decrease the tolerance of the kidney to radiation injury.
1980年至1987年间，59例急性淋巴细胞白血病（ALL）或IV期神经母细胞瘤（NB）患儿接受了异基因或自体骨髓移植（BMT）。其中39例患者在BMT后6个月存活且处于缓解期，可纳入本分析。16例出现肾功能不全。8例因复发性ALL接受自体移植。预处理方案包括替尼泊苷（VM 26）、阿糖胞苷和环磷酰胺，随后进行全身照射（TBI）。1例患者单次接受850 cGy照射，而其他所有患者均接受分次TBI（3 - 4天内分6 - 8次给予1200 - 1400 cGy）。11例接受NB移植且可评估的患者中有8例出现晚期肾脏问题（BMT后4 - 7个月）。神经母细胞瘤患者的预处理方案包括VM 26、顺铂、美法仑、环磷酰胺和分次TBI（1200 - 1296 cGy）。所有8例神经母细胞瘤患者在移植前均接受过顺铂诱导治疗。所有患者均出现贫血、血尿以及血尿素氮和肌酐升高。肾活检结果符合放射性肾病。总之，神经母细胞瘤和ALL患儿在BMT后出现肾功能不全的发生率较高。临床和实验室特征与放射性肾病或溶血尿毒综合征相符。这些患者相对年轻，且接受强化多药化疗预处理，可能会降低肾脏对辐射损伤的耐受性。
