Bone marrow transplantation nephropathy after an intensified conditioning regimen with radioimmunotherapy and allogeneic stem cell transplantation.
Intensification of the conditioning regimen with a radioactively labeled anti-CD66 antibody is feasible before allogeneic stem cell transplantation. The use of radioimmunotherapy may deliver a significant dose of radiation to the kidneys. We therefore studied the incidence and clinical picture of bone marrow transplantation (BMT) nephropathy in our patients receiving radioimmunotherapy before allogeneic stem cell transplantation.


METHODS
This study was a clinical trial of 114 consecutive patients who received conditioning with a radiolabeled anti-CD66 antibody-188Re (n = 93) or 90Y (n = 21)-between 1998 and 2003.


RESULTS
Although BMT nephropathy has developed in none of the patients in the [90Y]anti-CD66 group, 6 of 93 patients receiving [188Re]anti-CD66 presented with signs of BMT nephropathy at a median of 11.5 mo after stem cell transplantation. The absorbed renal dose was significantly lower in the 90Y group (4 vs. 7 Gy, P < 0.0001). Of the patients receiving [188Re]anti-CD66 who are alive, BMT nephropathy developed in 19% (6/32). Five of 6 patients with BMT nephropathy received total-body irradiation. The patients presented with elevated serum creatinine, proteinuria, anemia, hypertension, and signs of microangiopathy. All 6 patients in whom BMT nephropathy has developed are alive at a median follow-up of 58 mo after stem cell transplantation, and 1 patient has entered a dialysis program.


CONCLUSIONS
BMT nephropathy appears to be a significant problem after allogeneic stem cell transplantation with intensified conditioning using the 188Re-labeled anti-CD66 applied in this study, particularly when combined with total-body irradiation.
Zenz
Thorsten
T
Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany.
Schlenk
Richard F
RF
Glatting
Gerhard
G
Neumaier
Bernd
B
Blumstein
Norbert
N
Buchmann
Inga
I
von Harsdorf
Stephanie
S
Ringhoffer
Mark
M
Wiesneth
Markus
M
Keller
Frieder
F
Kotzerke
Jörg
J
Röttinger
Erwin
E
Stilgenbauer
Stephan
S
Döhner
Hartmut
H
Reske
Sven N
SN
Bunjes
Donald
D
D000293:Adolescent; D000328:Adult; D001853:Bone Marrow / Q000528:radiation effects*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology*; D007938:Leukemia / Q000150:complications / Q000532:radiotherapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D016499:Radioimmunotherapy / Q000009:adverse effects* / Q000379:methods; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous; D016896:Treatment Outcome