The Importance of Age, Fludarabine, and Total Body Irradiation in the Incidence and Severity of Chronic Renal Failure after Allogeneic Hematopoietic Cell Transplantation

Julio Delgado, Nichola Cooper, Kirsty Thomson, Rafael Duarte, Michael Jarmulowicz, Anna Cassoni, Panagiotis Kottaridis, Karl Peggs, Stephen Mackinnon
2006 Biology of Blood and Marrow Transplantation  
Nonmalignant late effects, including chronic renal failure (CRF), impair the quality of life of long-term survivors after allogeneic hematopoietic cell transplantation. One of the major risk factors is the use of total body irradiation (TBI) in the preparative regimen; TBI is currently fractionated in an attempt to reduce toxicity. We analyzed 241 patients who had TBI-based preparative regimens for allogeneic hematopoietic cell transplantation. TBI was delivered as a single fraction of 7.5 Gy
more » ... raction of 7.5 Gy (7.5S group), 12 Gy in 6 fractions (12F group), or 14.4 Gy in 8 fractions (14.4F group). The cumulative incidence of CRF at 2 years was 12%. Statistical analysis revealed that older age (P < .001) and fludarabine administration (P ‫؍‬ .016) had a significant effect on the incidence of CRF. Furthermore, single-fraction TBI was also significantly associated with CRF severity, because 7 (6.3%) of 111 patients in the 7.5S group developed severe CRF, as opposed to 1 (0.8%) of 130 patients in the 12F and 14.4F groups combined (P ‫؍‬ .044). However, these conclusions should be regarded as preliminary in view of the retrospective and nonrandomized nature of this study.
doi:10.1016/j.bbmt.2005.08.036 pmid:16399571 fatcat:ils4v5t4ire2ta33j22k7zwpni