Summary:We report a patient with pre-existing end-stage renal disease (ESRD) who underwent successful matched related donor allogeneic bone marrow transplantation for AML in second complete remission (CR2) using conditioning with high-dose cyclophosphamide (CY, 60 mg/kg/day ؋ 2) and TBI (165 cGy twice daily ؋ 4 days). The timing of hemodialysis after high-dose CY was extrapolated from available data on the pharmacokinetics of high-dose CY and hemodialysis clearance of conventional dose CY and its metabolites. Pharmacokinetic analyses indicated that the elimination of highdose CY and its alkylating metabolites is impaired in ESRD but is cleared with hemodialysis. The patient's early post-transplant course was uncomplicated, and WBC and platelet engraftment occurred by day ؉22. Bone marrow examination on day ؉25 showed trilineage engraftment with no AML; cytogenetics showed 100% donor karyotype. The patient remains in remission with 100% donor karyotype at 3 years post transplant. Clinical results indicate that the administration of high-dose CY is feasible with hemodialysis support for patients with ESRD. Keywords: allogeneic BMT; renal disease; cyclophosphamide; AML; pharmacokinetics; hemodialysis High-dose chemotherapy with BMT is considered to be contraindicated in patients with severe renal dysfunction since it is often assumed that the pharmacokinetics and/or pharmacodynamics of high-dose chemotherapy are significantly altered. High-dose cyclophosphamide (CY) is a common component of preparative regimens. The effect of renal dysfunction on the pharmacokinetics of high-dose CY is not known although pharmacokinetic models suggest that Correspondence: Dr JJ Perry, Section of Hematology/Oncology, Department of Internal Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157 Received 9 July 1998; accepted 12 November 1998 clearance of two important CY metabolites, 4-OH CY and aldophosphamide, may be reduced if severe renal impairment is present.1 The pharmacokinetics of conventionaldose CY and its alkylating metabolites are altered in patients with renal insufficiency.2,3 However, the toxicity profile has not been reported to be different from patients with normal renal function 4 leading some authors to suggest that conventional doses of CY do not require modification in patients with renal dysfunction. 5 In this report, we describe the clinical BMT course of a patient with endstage renal disease (ESRD) (on chronic hemodialysis) and AML in CR2 who received high-dose CY. The pharmacokinetics of high-dose CY and CY-alkylating metabolites are also presented. Case reportA 42-year-old male was diagnosed with AML (subtype FAB-M2) in January 1994. He achieved CR after treatment with daunorubicin 45 mg/m 2 i.v. × 3 days and cytarabine 100 mg/m 2 /day by continuous i.v. infusion (CIVI) ϫ 7 days. He was given four courses of post-remission therapy using daunorubicin 45 mg/m 2 i.v. ϫ 2 days and cytarabine 100 mg/m 2 /day CIVI ϫ 5 days, completed in July 1994. ...

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Background Hispanics are the fastest growing minority group in the United States, and approximately 10% of all end-stage renal disease (ESRD) patients are Hispanic. Few data are available, however, regarding dialysis adequacy and anemia management in Hispanic patients receiving peritoneal dialysis in the U.S. Methods Data from the Health Care Financing Administration (HCFA) ESRD Core Indicators Project were used to assess racial and ethnic differences in selected intermediate outcomes for peritoneal dialysis patients. Results Of the 1219 patients for whom data were available from the 1997 sample, 9% were Hispanic, 24% were non-Hispanic blacks, and 59% were non-Hispanic whites. Hispanics were more likely to have diabetes mellitus as a cause of ESRD compared to blacks or whites, and both Hispanics and blacks were younger than white patients (both p < 0.001). Although whites had higher weekly Kt/V and creatinine clearance values compared to blacks or Hispanics ( p < 0.05), blacks had been dialyzing longer ( p < 0.01) and were more likely to be anuric compared to the other two groups ( p < 0.001). Blacks had significantly lower mean hematocrit values ( p < 0.001) and a greater proportion of patients who had a hematocrit level less than 28% ( p < 0.05) compared to Hispanics or whites, despite receiving significantly larger weekly mean epoetin alfa doses ( p < 0.05) and having significantly higher mean serum ferritin concentrations ( p < 0.01). Multivariate logistic regression analysis revealed significant differences by race/ethnicity for experiencing a weekly Kt/V urea < 2.0 and hypertension, but not for other intermediate outcomes examined (weekly creatinine clearance < 60 L/week/1.73 m2, Hct < 30%, and serum albumin < 3.5/3.2 g/dL). Conclusion Hispanics had adequacy values similar to blacks and anemia parameters similar to whites. Additional studies are needed to determine the etiologies of the differences in intermediate outcomes by racial and ethnic groupings in peritoneal dialysis patients.