title: The importance of age, fludarabine, and total body irradiation in the incidence and severity of chronic renal failure after allogeneic hematopoietic cell transplantation.
abstract: Nonmalignant late effects, including chronic renal failure (CRF), impair the quality of life of long-term survivors after allogeneic hematopoietic cell transplantation. One of the major risk factors is the use of total body irradiation (TBI) in the preparative regimen; TBI is currently fractionated in an attempt to reduce toxicity. We analyzed 241 patients who had TBI-based preparative regimens for allogeneic hematopoietic cell transplantation. TBI was delivered as a single fraction of 7.5 Gy (7.5S group), 12 Gy in 6 fractions (12F group), or 14.4 Gy in 8 fractions (14.4F group). The cumulative incidence of CRF at 2 years was 12%. Statistical analysis revealed that older age (P < .001) and fludarabine administration (P = .016) had a significant effect on the incidence of CRF. Furthermore, single-fraction TBI was also significantly associated with CRF severity, because 7 (6.3%) of 111 patients in the 7.5S group developed severe CRF, as opposed to 1 (0.8%) of 130 patients in the 12F and 14.4F groups combined (P = .044). However, these conclusions should be regarded as preliminary in view of the retrospective and nonrandomized nature of this study.
authors.affiliation: Department of Hematology, Royal Free & University College Medical School, London, United Kingdom. julio.delgado@heartofengland.nhs.uk
authors.forename: Julio
authors.initials: J
authors.lastname: Delgado
authors.forename: Nichola
authors.initials: N
authors.lastname: Cooper
authors.forename: Kirsty
authors.initials: K
authors.lastname: Thomson
authors.forename: Rafael
authors.initials: R
authors.lastname: Duarte
authors.forename: Michael
authors.initials: M
authors.lastname: Jarmulowicz
authors.forename: Anna
authors.initials: A
authors.lastname: Cassoni
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kottaridis
authors.forename: Karl
authors.initials: K
authors.lastname: Peggs
authors.forename: Stephen
authors.initials: S
authors.lastname: Mackinnon
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004307:Dose-Response Relationship, Radiation; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives*; D014916:Whole-Body Irradiation / Q000009:adverse effects*
chemical_list: D014740:Vidarabine; C024352:fludarabine