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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Renal toxicity in children undergoing total body irradiation for bone marrow transplant.
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Renal toxicity in children undergoing total body irradiation for bone marrow transplant.

机译：对接受骨髓移植的全身照射儿童的肾毒性。

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PURPOSE: Contribution of total body irradiation (TBI) to renal toxicity in children undergoing the bone marrow transplant (BMT) remains controversial. We report our institutional retrospective study that evaluates the frequency of acute and chronic renal dysfunction in children after using total body irradiation (TBI) conditioning regimens. MATERIALS AND METHODS: Between 1995 and 2003, 60 children with hematological malignancies underwent TBI as part of a conditioning regimen before allogeneic BMT. Patients received 4-14Gy at 1.75-2Gy/fraction in six-eight fractions. Lung shielding was used in all patients to limit lung dose to less than 10Gy; renal shielding was not utilized. All patients had baseline renal function assessment and renal dysfunction post-BM was mainly evaluated on the basis of persistent serum creatinine elevation at acute (0-90 days) and chronic (>90 days) intervals after completion of BMT. RESULTS: Acute renal dysfunction (ARD) was documented in 27 patients (45%); the majority had concurrent diagnosis of veno-occlusive disease (VOD) or graft-versus-host disease (GVHD) and other potential causes (sepsis, antibiotic). The risk for delayed renal dysfunction (DRD) at 1 year approached 25% for surviving patients. The ARD was strongly linked with the risk of the DRD. There was no statistically significant relationship between ARD, DRD and underlying diagnosis, GVHD, VOD or TBI doses with both univariate and multivariate analyses. The younger age (<5 years) had significantly increased risk for the development of ARD (p=0.011). CONCLUSION: Our analysis validates high incidence of renal dysfunction in the pediatric BMT population. In contrast to other reports we did not find total body irradiation dose to be a risk factor for renal dysfunction. Future prospective studies are needed to assess risk factors and interventions for this serious toxicity in children following allogeneic BM.
机译：目的：全身照射（TBI）对接受骨髓移植（BMT）的儿童的肾毒性的贡献仍存在争议。我们报告了我们的机构回顾性研究，该研究评估了使用全身照射（TBI）调理方案后儿童的急性和慢性肾功能不全的频率。材料与方法：在1995年至2003年之间，对60例血液系统恶性肿瘤患儿进行了TBI，这是在接受异基因BMT之前进行的一项调理方案。患者以六分之八的分数以1.75-2Gy /分数接受4-14Gy。所有患者均采用肺部防护以将肺部剂量限制在10Gy以下。没有使用肾脏屏蔽。所有患者均接受基线肾功能评估，BM后的肾功能不全主要根据BMT完成后急性（0-90天）和慢性（> 90天）持续的血清肌酐升高进行评估。结果：27例患者（45％）有急性肾功能不全（ARD）的记录。大多数患者同时诊断有静脉闭塞性疾病（VOD）或移植物抗宿主病（GVHD）和其他潜在原因（败血症，抗生素）。存活患者在1年后出现延迟性肾功能不全（DRD）的风险接近25％。 ARD与DRD的风险密切相关。在单变量和多变量分析中，ARD，DRD与基础诊断，GVHD，VOD或TBI剂量之间无统计学意义的相关性。年龄小于5岁的年轻人发生ARD的风险显着增加（p = 0.011）。结论：我们的分析证实了小儿BMT人群中肾功能不全的发生率很高。与其他报告相反，我们没有发现全身照射剂量是肾功能不全的危险因素。需要进一步的前瞻性研究来评估同种异体BM患儿这种严重毒性的危险因素和干预措施。

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