Bone marrow transplantation nephropathy after an intensified conditioning regimen with radioimmunotherapy and allogeneic stem cell transplantation

Thorsten Zenz, Richard F Schlenk, Gerhard Glatting, Bernd Neumaier, Norbert Blumstein, Inga Buchmann, Stephanie von Harsdorf, Mark Ringhoffer, Markus Wiesneth, Frieder Keller, Jörg Kotzerke, Erwin Röttinger, Stephan Stilgenbauer, Hartmut Döhner, Sven N Reske, Donald Bunjes

Abstract

UNLABELLED: Intensification of the conditioning regimen with a radioactively labeled anti-CD66 antibody is feasible before allogeneic stem cell transplantation. The use of radioimmunotherapy may deliver a significant dose of radiation to the kidneys. We therefore studied the incidence and clinical picture of bone marrow transplantation (BMT) nephropathy in our patients receiving radioimmunotherapy before allogeneic stem cell transplantation.

METHODS: This study was a clinical trial of 114 consecutive patients who received conditioning with a radiolabeled anti-CD66 antibody-188Re (n = 93) or 90Y (n = 21)-between 1998 and 2003.

RESULTS: Although BMT nephropathy has developed in none of the patients in the [90Y]anti-CD66 group, 6 of 93 patients receiving [188Re]anti-CD66 presented with signs of BMT nephropathy at a median of 11.5 mo after stem cell transplantation. The absorbed renal dose was significantly lower in the 90Y group (4 vs. 7 Gy, P < 0.0001). Of the patients receiving [188Re]anti-CD66 who are alive, BMT nephropathy developed in 19% (6/32). Five of 6 patients with BMT nephropathy received total-body irradiation. The patients presented with elevated serum creatinine, proteinuria, anemia, hypertension, and signs of microangiopathy. All 6 patients in whom BMT nephropathy has developed are alive at a median follow-up of 58 mo after stem cell transplantation, and 1 patient has entered a dialysis program.

CONCLUSION: BMT nephropathy appears to be a significant problem after allogeneic stem cell transplantation with intensified conditioning using the 188Re-labeled anti-CD66 applied in this study, particularly when combined with total-body irradiation.

OriginalspracheEnglisch
ZeitschriftJournal of nuclear medicine : official publication, Society of Nuclear Medicine
Jahrgang47
Ausgabenummer2
Seiten (von - bis)278-86
Seitenumfang9
ISSN0161-5505
PublikationsstatusVeröffentlicht - 02.2006

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