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Long-Term Renal Toxicity in Children Following Fractionated Total-Body Irradiation (TBI) Before Allogeneic Stem Cell Transplantation (SCT)

Renale Spättoxizität im Kindesalter nach fraktionierter Ganzkörperbestrahlung (TBI) vor allogener Stammzelltransplantation (SCT)

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Purpose:

To retrospectively assess the incidence and time course of renal dysfunction in children (≤ 16 years) following total- body irradiation (TBI) before allogeneic stem cell transplantation (SCT).

Patients and 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%.

Conclusion:

The incidence of persistent renal dysfunction after fractionated TBI with total doses ≤ 12 Gy was very low in this analysis.

Ziel:

In einer retrospektiven Analyse wurden die Inzidenz und der zeitliche Verlauf der renalen Spattoxizitat bei Kindern (≤ 16 Jahre) nach Ganzkorperbestrahlung (TBI) vor allogener Stammzelltransplantation (SCT) untersucht.

Patienten und Methodik:

Von 1986 bis 2003 erhielten 92 Kinder (medianes Alter 11 Jahre; Streubreite 3–16 Jahre) eine fraktionierte TBI vor allogener SCT. 43 Patienten wiesen eine Nachbeobachtungszeit von mindestens 12 Monaten auf (median 51 Monate; Streubreite 12–186 Monate) und gingen in diese Analyse ein. Die Konditionierung bestand aus einer Chemotherapie und einer fraktionierten TBI mit 12 Gy (n = 26) bzw. 11,1 Gy (n = 17). Bei einem Patienten wurde aufgrund einer vorbestehenden Nephropathie die Nierendosis durch individuelle Ausblockung auf 10 Gy begrenzt. Als renale Dysfunktion wurde ein Anstieg des Serumkreatinins uber das 1,25fache des jeweils altersabhangigen oberen Grenzwerts nach SCT definiert.

Ergebnisse:

Zwolf Kinder (28%) entwickelten eine renale Dysfunktion median 2 Monate nach SCT (Streubreite 1–10 Monate). Bei elf dieser Patienten war die renale Dysfunktion temporar mit Normalisierung nach median 8 Monaten (Streubreite 3–16 Monate). Nur bei einem Kind lag eine persistierende renale Dysfunktion vor, die 10 Monate nach SCT auftrat. Keines dieser Kinder wurde dialysepflichtig. Die aktuarische 3-Jahres-Freiheit von persistierenden renalen Funktionseinschrankungen bei Kindern mit einem Nachbeobachtungszeitraum von mindestens 12 Monaten nach SCT betrug 97,3%.

Schlussfolgerung:

Die Inzidenz einer persistierenden renalen Dysfunktion nach fraktionierter TBI mit einer Gesamtdosis ≤ 12 Gy war in dieser Analyse sehr niedrig.

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Authors and Affiliations

  1. Department of Radiation Oncology, Medical School Hannover, Hannover, Germany

    Johanna Gerstein, Andreas Meyer, Jörg Frühauf, Johann H. Karstens & Michael Bremer

  2. Department of Pediatric Hematology and Oncology, Medical School Hannover, Hannover, Germany

    Karl-Walter Sykora

  3. Klinik für Strahlentherapie und Onkologie, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany

    Johanna Gerstein

Authors
  1. Johanna Gerstein
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  2. Andreas Meyer
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  4. Jörg Frühauf
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  5. Johann H. Karstens
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  6. Michael Bremer
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Correspondence to Johanna Gerstein.

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Gerstein, J., Meyer, A., Sykora, KW. et al. Long-Term Renal Toxicity in Children Following Fractionated Total-Body Irradiation (TBI) Before Allogeneic Stem Cell Transplantation (SCT). Strahlenther Onkol 185, 751–755 (2009). https://doi.org/10.1007/s00066-009-2022-8

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  • DOI: https://doi.org/10.1007/s00066-009-2022-8

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