Chronic kidney disease, thrombotic microangiopathy, and hypertension following T cell-depleted hematopoietic stem cell transplantation Journal Article

   


Authors: Glezerman, I. G.; Jhaveri, K. D.; Watson, T. H.; Edwards, A. M.; Papadopoulos, E. B.; Young, J. W.; Flombaum, C. D.; Jakubowski, A. A.
Article Title: Chronic kidney disease, thrombotic microangiopathy, and hypertension following T cell-depleted hematopoietic stem cell transplantation
Abstract: Chronic kidney disease (CKD) is now an accepted long-term complication of allogeneic hematopoietic stem cell transplantation. Calcineurin inhibitors (CNI), which are used for prophylaxis and treatment of graft-versus-host disease (GVHD), have been associated with the development of nephrotoxicity. Hypertension (HTN) and thrombotic microangiopathy (TMA) are 2 comorbidities linked to CKD. T cell depletion (TCD) of stem cell grafts can obviate the need for the use of CNI. We conducted a retrospective analysis of 100 patients who underwent TCD transplantation: 30 in group A were conditioned without total-body radiation (TBI) and 70 in group B received a TBI containing regimen. None of the patients received CNI. The median age was 55.5 and 45 years for groups A and B, respectively. Eleven patients developed TMA, all in group B. The 2-year cumulative incidence of sustained CKD was 29.2% and 48.8% in group A and group B, respectively, with a mean follow-up of at least 21 months. CKD free survival was better in the non-TBI group (P = .046). Multivariable survival analysis revealed that exposure to TBI, older age, and TMA were risk factors for CKD. The incidence of new onset or worsening HTN was 6.7% and 25.7% (P = .03) in group A and B, respectively. The use of TBI (P = .0182) and diagnosis of TMA (P = .0006) predisposed patients to the development of HTN using univariable logistic regression models. Thus, despite the absence of CNI, a proportion of these older patients in both groups developed CKD and HTN. © 2010 American Society for Blood and Marrow Transplantation.
Keywords: adult; controlled study; human tissue; disease-free survival; middle aged; retrospective studies; transplantation, homologous; major clinical study; busulfan; fludarabine; hypertension; radiation dose; t-lymphocytes; incidence; melphalan; creatinine blood level; hematopoietic stem cell transplantation; risk factor; thiotepa; survivors; acute graft versus host disease; chronic graft versus host disease; disease severity; whole body radiation; kidney function; chronic kidney disease; comorbidity; glomerulus filtration rate; t cell depletion; disease predisposition; disease exacerbation; kidney biopsy; thrombotic thrombocytopenic purpura; blood pressure measurement; thymocyte antibody; thrombotic microangiopathy; kidney failure, chronic; budesonide; thrombotic microangiopathies
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 16
Issue: 7
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2010-07-01
Start Page: 976
End Page: 984
Language: English
DOI: 10.1016/j.bbmt.2010.02.006
PUBMED: 20153836
PROVIDER: scopus
PMCID: PMC2916080
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-77953614020&partnerID=40&md5=538929897457e2cb91aa3f4356fa5eb3
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: BBMTF" - "Source: Scopus"
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MSK Authors
  1. Ilya Gregory Glezerman
    83 Glezerman
  2. Esperanza B Papadopoulos
    415 Papadopoulos
  3. Ann Jakubowski
    455 Jakubowski
  4. James W Young
    318 Young
  5. Carlos D Flombaum
    53 Flombaum
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