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Renal dysfunction following autologous bone marrow transplantation in adult patients with acute leukemia
Insights
Autologous bone marrow transplantation (ABMT) for acute leukemia rarely causes long-term kidney problems. Most patients remain free of significant renal dysfunction one year after ABMT, with relapse being a risk factor.
Area of Science:
- Nephrology
- Hematology
- Oncology
Background:
- Acute leukemia treatment often involves intensive therapies like autologous bone marrow transplantation (ABMT).
- Long-term complications, particularly renal dysfunction, require careful evaluation post-ABMT.
Purpose of the Study:
- To determine the incidence and risk factors of renal dysfunction one year after autologous bone marrow transplantation in adult acute leukemia survivors.
- To assess the long-term renal function in patients undergoing ABMT for acute leukemia.
Main Methods:
- Serum creatinine levels were monitored in 70 adults with acute leukemia at baseline, 1 year post-ABMT, and at last follow-up (median 35 months).
- Clinically significant renal impairment was defined as a serum creatinine level >120 micromol/l.
- Incidence of renal impairment was compared between patients in continuous remission and those who relapsed.
Main Results:
- The incidence of renal impairment was low at 1 year (2.9%) and last follow-up (4.3%) in patients in continuous remission.
- Significant renal impairment was more common in patients who relapsed (8/12) compared to those in remission (3/58, p < 0.001).
- This suggests subclinical renal damage may become apparent with further nephrotoxic treatments, particularly after relapse.
Conclusions:
- Clinically significant renal dysfunction is an uncommon long-term complication following autologous bone marrow transplantation for acute leukemia.
- Renal function should not be a primary concern when recommending ABMT to eligible patients.
- Relapse of leukemia appears to be associated with an increased risk of developing renal impairment post-ABMT.
Abstract:
The serum creatinine level was used to determine the incidence of renal dysfunction in 70 adults with acute leukemia who were alive and well one year following autologous bone marrow transplantation (ABMT). Creatinine measurements at the time of ABMT, one year post-ABMT and at the last follow-up (12-128 months, median 35) were recorded, and a level of >120 micromol/l arbitrarily defined as clinically significant renal impairment. The incidence of renal impairment was 2.9% (n = 2) at 1 year, and 4.3% (n = 3) at the last follow-up in continuous remission. Significant renal impairment occurred after relapse in 8 of 12 patients, but was seen in only 3 of 58 patients who remained in remission (p < 0.001, Fisher's exact test), suggesting subclinical renal damage which became obvious with further nephrotoxic therapy. We conclude that clinically significant renal dysfunction is an uncommon long-term complication of ABMT, and should not be a concern in recommending this therapy to eligible patients.