Delayed renal dysfunction after total body irradiation in pediatric malignancies

Area of Science:

• Pediatric Oncology
• Nephrology
• Radiation Oncology

Background:

• Total body irradiation (TBI) is a critical component of conditioning regimens for hematopoietic stem cell transplantation (HSCT).
• Long-term survivors of TBI/HSCT may experience delayed adverse effects, including renal dysfunction.
• Understanding the incidence and risk factors for delayed renal dysfunction is crucial for improving long-term outcomes in pediatric HSCT survivors.

Purpose of the Study:

• To retrospectively evaluate the incidence of delayed renal dysfunction in long-term pediatric survivors of TBI/HSCT.
• To identify potential associations between TBI dose/schedule and the development of renal dysfunction.

Main Methods:

• Retrospective analysis of 9 pediatric patients who survived >5 years after TBI/HSCT.
• Assessment of renal function using estimated glomerular filtration rate (eGFR) over a median follow-up of 140 months.
• Review of TBI dose (8-12 Gy in 3-6 fractions over 2-3 days) and treatment techniques.

Main Results:

• Four out of nine patients (44.4%) showed a progressive decrease in eGFR.
• No patients required hemodialysis; only one developed hypertension.
• A TBI schedule of 12 Gy in 6 fractions over three consecutive days was suggested to affect renal function.

Conclusions:

• Delayed renal dysfunction is a potential long-term complication in pediatric TBI/HSCT survivors.
• Monitoring eGFR is essential for detecting renal dysfunction in this patient population.
• Specific TBI fractionation schedules, such as 12 Gy in 6 fractions, may warrant closer renal function surveillance.