Tarbell N J, Guinan E C, Niemeyer C, Mauch P, Sallan S E, Weinstein H J
Department Radiation Therapy, Joint Center for Radiation Therapy, Harvard Medical School, Boston, MA 02115.
Int J Radiat Oncol Biol Phys. 1988 Jul;15(1):99-104. doi: 10.1016/0360-3016(88)90352-5.
Between 1980 and 1986, 44 children with acute lymphoblastic leukemia (ALL) or Stage IV neuroblastoma (NB) underwent allogeneic or autologous bone marrow transplantation (BMT). Twenty-nine of these patients were alive and in remission 3 months post BMT and were evaluable for this analysis of whom eleven have developed renal dysfunction. Six of 17 (35%) evaluable ALL patients developed renal dysfunction (3.5 to 6 months post BMT). This group was transplanted for CALLA positive 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). Five of 7 (71%) evaluable patients who received a BMT for NB have developed late renal problems (4-7 months after BMT). The preparation for NB patients included VM 26, cis-platinum, melphalan, cyclophosphamide, and fractionated TBI (1200-1296 cGy). All seven NB patients had received cis-platinum as induction treatment prior to transplantation. All patients presented with anemia, hematuria, and elevations of BUN and creatinine. Two patients underwent renal biopsies which were consistent with radiation nephropathy or hemolytic uremic syndrome. In conclusion, a high incidence of renal dysfunction has occurred 3 to 7 months after BMT for children with NB and ALL. The clinical and laboratory features are consistent with either acute radiation nephropathy or hemolytic-uremic syndrome. These patients were prepared for BMT with multiple chemotherapeutic agents as well as TBI. 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1986年间，44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29例患者在BMT后3个月存活且处于缓解期，可纳入本分析，其中11例出现肾功能不全。17例可评估的ALL患者中有6例（35%）出现肾功能不全（BMT后3.5至6个月）。该组患者因CALLA阳性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，而其他所有患者接受分次TBI（在3 - 4天内分6 - 8次给予1200 - 1400 cGy）。7例接受NB BMT的可评估患者中有5例（71%）出现晚期肾脏问题（BMT后4 - 7个月）。NB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7例NB患者在移植前均接受顺铂作为诱导治疗。所有患者均出现贫血、血尿以及血尿素氮和肌酐升高。2例患者接受了肾活检，结果符合放射性肾病或溶血尿毒综合征。总之，NB和ALL患儿在BMT后3至7个月出现肾功能不全的发生率较高。临床和实验室特征与急性放射性肾病或溶血尿毒综合征一致。这些患者接受了多种化疗药物以及TBI的BMT预处理。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。
