Renal dysfunction during high-dose cisplatin therapy and autologous hematopoietic stem cell transplantation: effect of aminoglycoside therapy.
OBJECTIVE
Renal dysfunction is a common cause of morbidity after cancer therapy and bone marrow transplantation. In this study, we evaluated the effects of aminoglycosides and other nephrotoxic antibiotics on the occurrence of renal dysfunction in patients who received high-dose cisplatin-containing chemotherapy regimens.


METHODS
The subjects of this analysis were 102 consecutive patients, studied from September 1985 to February 1991, who received high-dose cisplatin, administered as 40 mg/m2 for 5 consecutive days in 3% saline with saline hydration and mannitol diuresis, followed by autologous stem cell transplantation. Renal dysfunction was defined as an increase in serum creatinine greater than or equal to 44.2 mumol/L above baseline.


RESULTS
Characteristics of the 43 patients who were given aminoglycosides were similar to those in patients who did not receive aminoglycosides with respect to initial renal function, age, cancer type, and previous exposure to cisplatin. Patients who experienced serious treatment-related toxicities such as hemorrhage or septicemia were more likely to have received aminoglycoside antibiotics (p = 0.005). A multivariate analysis showed that increased duration of neutropenia, advanced patient age, and amphotericin B use were predictors of renal failure. Aminoglycoside therapy did not significantly increase the risk of renal dysfunction.


CONCLUSIONS
Our data suggest that with appropriate supportive care measures, aminoglycosides can safely be administered to febrile, neutropenic patients who recently have received high-dose cisplatin therapy.
Cooper
Brenda W
BW
From the Department of Medicine, Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio USA.
Creger
Richard J
RJ
From the Department of Medicine, Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio USA.
Soegiarso
Wida
W
From the Department Biostatistics, Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio USA.
Mackay
Wilma L
WL
From the Department Biostatistics, Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio USA.
Lazarus
Hillard M
HM
From the Department of Medicine, Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio USA.
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000209:etiology / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D000368:Aged; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D016026:Bone Marrow Transplantation; D002945:Cisplatin / Q000009:adverse effects*; D000075202:Contraindications; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000628:therapy; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications / Q000628:therapy; D012307:Risk Factors
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002945:Cisplatin