Long-term renal toxicity in children following fractionated total-body irradiation (TBI) before allogeneic stem cell transplantation (SCT).
OBJECTIVE
To retrospectively assess the incidence and time course of renal dysfunction in children (< or = 16 years) following total- body irradiation (TBI) before allogeneic stem cell transplantation (SCT).


METHODS
Between 1986 and 2003, 92 children (median age, 11 years; range, 3-16 years) underwent TBI before allogeneic SCT. 43 of them had a minimum follow-up of 12 months (median, 51 months; range, 12-186 months) and were included into this analysis. Conditioning regimen included chemotherapy and fractionated TBI with 12 Gy (n = 26) or 11.1 Gy (n = 17). In one patient, renal dose was limited to 10 Gy by customized renal shielding due to known nephropathy prior to SCT. Renal dysfunction was defined as an increase of serum creatinine > 1.25 times the upper limit of age-dependent normal.


RESULTS
Twelve children (28%) experienced an episode of renal dysfunction after a median of 2 months (range, 1-10 months) following SCT. In all but one patient renal dysfunction was transient and resolved after a median of 8 months (range, 3-16 months). One single patient developed persistent renal dysfunction with onset at 10 months after SCT. None of these patients required dialysis. The actuarial 3-year freedom from persistent renal toxicity for children surviving > 12 months after SCT was 97.3%.


CONCLUSIONS
The incidence of persistent renal dysfunction after fractionated TBI with total doses < or = 12 Gy was very low in this analysis.
Gerstein
Johanna
J
Department of Radiation Oncology, Medical School Hannover, Hannover, Germany. Johanna.Gerstein@kgu.de
Meyer
Andreas
A
Sykora
Karl-Walter
KW
Frühauf
Jörg
J
Karstens
Johann H
JH
Bremer
Michael
M
D000206:Actuarial Analysis; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007668:Kidney / Q000528:radiation effects*; D007677:Kidney Function Tests; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology*; D012074:Remission Induction; D019172:Transplantation Conditioning; D014916:Whole-Body Irradiation
D003404:Creatinine