Late-onset unilateral renal dysfunction combined with non-insulin-dependent diabetes mellitus and bronchial asthma following allogeneic bone marrow transplantation for acute lymphoblastic leukemia in a child.
We report a child with T cell acute lymphoblastic leukemia who developed late-onset multiple complications after allogeneic bone marrow transplantation from an HLA-matched sibling. The preparative regimen consisted of total body irradiation (TBI, 12 Gy), splenic irradiation (6 Gy) and cytosine arabinoside (3 g/m2 x 10). Splenic irradiation was added because of persistent splenomegaly in spite of intensive chemotherapy. He developed bronchial asthma 1 1/2 years post transplant. He presented with microhematuria and proteinuria 4 1/2 years post-transplant, which were due to unilateral left renal dysfunction. He developed type II, non-insulin-dependent diabetes mellitus 8 years post-transplant. A biopsy from the left kidney was not compatible with diabetic nephropathy. All these complications appear to be independently related to BMT, particularly TBI and/or splenic irradiation.
Hirayama
M
M
Department of Pediatrics and Clinical Immunology, Mie University, Japan.
Azuma
E
E
Kumamoto
T
T
Qi
J
J
Kobayashi
M
M
Komada
Y
Y
Inui
T
T
Miyake
M
M
Mugishima
H
H
Hamazaki
M
M
Sakurai
M
M
D000293:Adolescent; D017668:Age of Onset; D001249:Asthma / Q000209:etiology*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology*; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D051437:Renal Insufficiency / Q000209:etiology*; D013997:Time Factors; D014184:Transplantation, Homologous