Evaluation of renal function in Turkish children receiving BFM-95 therapy for acute lymphoblastic leukemia

Area of Science:

• Pediatric Oncology
• Nephrology
• Pharmacology

Background:

• Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
• Treatment protocols, such as BFM-95, often involve high-dose methotrexate (HDMTX).
• Renal function monitoring is crucial during and after cancer therapy.

Purpose of the Study:

• To assess the acute and long-term effects of HDMTX consolidation therapy on renal function in pediatric ALL patients.
• To determine the incidence of glomerular and tubular abnormalities post-HDMTX treatment.
• To evaluate for clinically significant late renal sequelae.

Main Methods:

• Longitudinal assessment of renal function in 42 children with ALL treated with the BFM-95 protocol.
• Three groups were studied: longitudinal (n=15) at 3 time points (pre-consolidation, 4 weeks post, 2-6 months post HDMTX), single time point post-consolidation (n=10), and single time point post-chemotherapy completion (n=17).
• Glomerular and tubular function tests were utilized.

Main Results:

• Acute renal toxicity, indicated by glomerular and tubular abnormalities, was frequent (13-40%) at 4 weeks post-HDMTX (T2) in the longitudinal group.
• Abnormalities persisted at lower rates (7-33%) at 2-6 months post-HDMTX (T3).
• A significant percentage (20%) of patients examined later (7-36 months post-consolidation) showed renal abnormalities, while only mild tubular issues were observed in patients long after chemotherapy completion (mean 56.1 months).

Conclusions:

• Consolidation therapy with HDMTX is frequently associated with acute renal toxicity in pediatric ALL patients.
• Clinically significant late renal sequelae do not appear to be a common outcome of this treatment regimen.
• Regular renal function monitoring is recommended during HDMTX therapy.