title: Bone marrow transplantation nephropathy after an intensified conditioning regimen with radioimmunotherapy and allogeneic stem cell transplantation.
abstract: 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.
authors.affiliation: Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Zenz
authors.forename: Richard F
authors.initials: RF
authors.lastname: Schlenk
authors.forename: Gerhard
authors.initials: G
authors.lastname: Glatting
authors.forename: Bernd
authors.initials: B
authors.lastname: Neumaier
authors.forename: Norbert
authors.initials: N
authors.lastname: Blumstein
authors.forename: Inga
authors.initials: I
authors.lastname: Buchmann
authors.forename: Stephanie
authors.initials: S
authors.lastname: von Harsdorf
authors.forename: Mark
authors.initials: M
authors.lastname: Ringhoffer
authors.forename: Markus
authors.initials: M
authors.lastname: Wiesneth
authors.forename: Frieder
authors.initials: F
authors.lastname: Keller
authors.forename: Jörg
authors.initials: J
authors.lastname: Kotzerke
authors.forename: Erwin
authors.initials: E
authors.lastname: Röttinger
authors.forename: Stephan
authors.initials: S
authors.lastname: Stilgenbauer
authors.forename: Hartmut
authors.initials: H
authors.lastname: Döhner
authors.forename: Sven N
authors.initials: SN
authors.lastname: Reske
authors.forename: Donald
authors.initials: D
authors.lastname: Bunjes
mesh_terms: 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