Takeuchi M, Tamaoki A, Tada A, Jyo Y, Nomura S, Takahashi K, Ohsawa G, Kibata M
Department of Internal Medicine, National Sanatorium Minami Okayama Hospital, Okayama, Japan.
Bone Marrow Transplant. 1998 Oct;22(7):725-7. doi: 10.1038/sj.bmt.1701410.
A 64-year-old woman underwent an ileocecal resection for ileus. The specimen revealed a diffuse large B cell lymphoma. The diagnosis was stage IIA non-Hodgkin's lymphoma. She received chemotherapy with the CHOP-etoposide regimen, resulting in partial remission. High-dose etoposide was used for PBSC mobilization before auto-PBSCT. Conditioning was ranimustine, carboplatin, etoposide and cyclophosphamide. Her renal function deteriorated gradually, starting 3 months post-PBSCT. Eight months post-transplant, serum creatine concentration was 7.1 mg/dl, and BUN was 59.2 mg/dl. Her hemoglobin concentration decreased to 5.3 g/dl, with no evidence of hemolysis. Renal biopsy revealed fibrous crescent formations in glomeruli, and mononuclear cell infiltration in interstitial spaces. Renal injury in this patient differs from BMT nephropathy, which is similar to hemolytic uremic syndrome, and represents another type of late renal injury after PBSCT.
一名64岁女性因肠梗阻接受了回盲部切除术。标本显示为弥漫性大B细胞淋巴瘤。诊断为IIA期非霍奇金淋巴瘤。她接受了CHOP-依托泊苷方案化疗，部分缓解。高剂量依托泊苷用于自体 PBSCT 前的外周血干细胞动员。预处理方案为雷莫司汀、卡铂、依托泊苷和环磷酰胺。自体 PBSCT 后3个月开始，她的肾功能逐渐恶化。移植后8个月，血清肌酐浓度为7.1 mg/dl，血尿素氮为59.2 mg/dl。她的血红蛋白浓度降至5.3 g/dl，无溶血证据。肾活检显示肾小球有纤维性新月体形成，间质有单核细胞浸润。该患者的肾损伤不同于骨髓移植肾病（类似于溶血尿毒综合征），是自体 PBSCT 后另一种类型的晚期肾损伤。
