Haemolytic uraemic syndrome and renal dysfunction following BEAC (BCNU, etoposide, ara-C, cyclophosphamide) +/- TBI and autologous BMT for malignant lymphomas.
Twenty-four patients autografted for malignant lymphoma have been followed. All were conditioned with BEAC (BCNU, etoposide, ara-C, cyclophosphamide), in 10 patients combined with total body irradiation (TBI) 7.5 Gy. Within 1 month of ABMT, a capillary leak syndrome was seen in four patients (one death) and isolated pericarditis in one. Nineteen patients survive disease-free at > or = 6 months, median (range) 24 (11-48) months. In 15 of 19 patients, a decrease in glomerular filtration rate (GFR) of > 20% was observed, 6 (6-24) months after ABMT. In six of these patients (five treated with TBI), the renal dysfunction was still progressing 11-36 months after ABMT. Five patients (four conditioned with TBI) developed a haemolytic uraemic syndrome (HUS) with Coombs negative haemolytic anaemia, platelet consumption and renal impairment, with onset 3-6 months after ABMT. Haemolysis and platelet consumption, but not renal impairment, were reversible in all patients. One death from HUS was seen. Because of the adverse effects described we have abandoned the combination of BEAC with TBI.
Carlson
K
K
Department of Internal Medicine, University Hospital, Uppsala, Sweden.
Smedmyr
B
B
Hagberg
H
H
Oberg
G
G
Simonsson
B
B
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005919:Glomerular Filtration Rate; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008223:Lymphoma / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014182:Transplantation, Autologous; D014916:Whole-Body Irradiation / Q000009:adverse effects
D003561:Cytarabine; D005047:Etoposide; D003520:Cyclophosphamide; D002330:Carmustine