Hemolytic uremic syndrome after bone marrow transplantation: clinical characteristics and outcome in children.
Hemolytic uremic syndrome (HUS) is an uncommon but potentially life-threatening complication of hematopoietic stem cell transplantation. We retrospectively studied the medical records of 293 children who underwent allogeneic bone marrow transplantation at St. Jude Children's Research Hospital between 1992 and 1999 to describe the clinical course of and to identify risk factors for transplant-associated HUS. Conditioning regimens included cyclophosphamide, cytarabine, and total body irradiation for patients with hematologic malignancies (n = 244); patients with nonmalignant diseases (n = 49) received disease-specific regimens. Grafts from unrelated or mismatched related donors were depleted of T lymphocytes, whereas matched sibling grafts were unmanipulated. All patients received cyclosporine as prophylaxis for graft-versus-host disease. Recipients of grafts from matched siblings also received pentoxifylline or short-course methotrexate. HUS developed in 28 (9.6%) patients at a median of 171 days after transplantation. We identified older donor age (P = .029), use of antithymocyte globulin in the conditioning regimen (P = .008), and recipient CMV seronegativity (P = .011) as being associated with an increased risk of HUS. With a multiple regression analysis, the use of antithymocyte globulin (beta = .86; P = .04) and recipient cytomegalovirus seronegativity (beta = .93; P = .035) remained significant risk factors for the development of HUS.
Hale
Gregory A
GA
Division of Stem Cell Transplantation, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA. gregory.hale@stjude.org
Bowman
Laura C
LC
Rochester
Richard J
RJ
Benaim
Eli
E
Heslop
Helen E
HE
Krance
Robert A
RA
Horwitz
Edwin M
EM
Cunningham
John M
JM
Tong
Xin
X
Srivastava
Deo Kumar
DK
Handgretinger
Rupert
R
Jones
Deborah P
DP
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000961:Antilymphocyte Serum / Q000009:adverse effects; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus; D006086:Graft vs Host Disease / Q000517:prevention & control; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000379:methods
D000961:Antilymphocyte Serum