异基因造血细胞移植后患者的慢性肾脏病。
Chronic Kidney Disease in Patients After Allogeneic Hematopoietic Cell Transplant.
机构信息
Department of Nephrology, Dialysis, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
Department of Hematology, Transplantation, and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
出版信息
Transplant Proc. 2022 May;54(4):1137-1140. doi: 10.1016/j.transproceed.2022.01.020. Epub 2022 Mar 10.
Hematopoietic stem cell transplant (HSCT) is used in advanced hematologic diseases to restart the immune system. Kidney damage remains significant complication of hematopoietic cell transplant (HCT) affecting the mortality of transplant recipients. The aim of the study was to assess the advancement of chronic kidney disease (CKD) in patients after HSCT. We studied 150 patients who underwent allo-HSCT treatment in our center in years 1995 to 2020 because of acute myeloid leukemia in 47% of patients, acute lymphoblastic leukemia in 19%, and lymphoma in 32%. The mean age of patients with acute leukemia is 48 years (including acute myeloid leukemia it is 47 years, and including acute lymphoblastic leukemia it is 32 years). The mean age of lymphoma patients is 34 years. We studied the prevalence and stages of CKD. CKD stage 3a and 3b was found in 24.6%. None of the patients studied had CKD stage 4 or 5. In patients after HSCT because of both acute myeloid leukemia and acute lymphoblastic leukemia, CKD stage 3a was found in 19% and stage 3b in 7.3%. Estimated glomerular filtration rate (eGFR) >90 mL/min/1.73 m, was found in 36.8% of this population, whereas eGFR between 90 and 60 mL/min/1.73 m was observed in 36.8%. In patients with lymphoma who underwent HSCT, CKD stage 3a was found in 18%, while CKD stage 3b was diagnosed in 27% of the patients. An eGFR >90 mL/min/1.73 m, was found in 27% of this population, whereas eGFR between 90 and 60 mL/min/1.73 m was observed in 27% of patients. The categorization of patients according to the underlying disease is important because other drugs are used in therapy of conditioning before HCT. CKD in patients after allogeneic HSCT is common, although advanced stages were not observed, probably because the age of the population studied was not advanced. CKD in these vulnerable patients may be because of prior chemotherapy, conditioning regimen, post-HSCT calcineurin therapy, and other possible nephrotoxic drugs.
造血干细胞移植（HSCT）用于治疗晚期血液病以重启免疫系统。肾损伤仍然是造血细胞移植（HCT）的严重并发症，影响移植受者的死亡率。本研究旨在评估 HSCT 后患者慢性肾脏病（CKD）的进展情况。我们研究了 1995 年至 2020 年间在我们中心接受同种异体 HSCT 治疗的 150 名患者，其中 47%的患者患有急性髓细胞白血病，19%的患者患有急性淋巴细胞白血病，32%的患者患有淋巴瘤。急性白血病患者的平均年龄为 48 岁（包括急性髓细胞白血病为 47 岁，急性淋巴细胞白血病为 32 岁）。淋巴瘤患者的平均年龄为 34 岁。我们研究了 CKD 的患病率和分期。发现 CKD 3a 和 3b 期分别占 24.6%。研究中没有患者患有 CKD 4 或 5 期。在因急性髓细胞白血病和急性淋巴细胞白血病而接受 HSCT 的患者中，3a 期 CKD 占 19%，3b 期 CKD 占 7.3%。估计肾小球滤过率（eGFR）>90 mL/min/1.73 m 者占该人群的 36.8%，而 eGFR 在 90 和 60 mL/min/1.73 m 之间者占 36.8%。接受 HSCT 的淋巴瘤患者中，3a 期 CKD 占 18%，3b 期 CKD 占 27%。该人群中 eGFR>90 mL/min/1.73 m 者占 27%，而 eGFR 在 90 和 60 mL/min/1.73 m 之间者占 27%。根据基础疾病对患者进行分类很重要，因为在 HCT 前的预处理中会使用其他药物。异基因 HSCT 后患者的 CKD 很常见，尽管未观察到晚期阶段，可能是因为研究人群的年龄没有增加。这些脆弱患者的 CKD 可能是由于先前的化疗、预处理方案、HSCT 后钙调神经磷酸酶治疗和其他可能的肾毒性药物引起的。
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