Renal function in high dose chemotherapy and autologous hematopoietic cell support treatment for breast cancer

Mérouani, Aïcha; Shpall, Elizabeth J.; Jones, Roy B.; Archer, Philip G.; Schrier, Robert W.

doi:10.1038/ki.1996.405

Cited by 67 publications

(51 citation statements)

References 13 publications

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“…[8][9][10][11][12] Acute kidney injury (AKI) is a common complication after myeloablative HCT and is associated with mortality. [13][14][15][16][17] In previous studies, 18,19 we employed the recently established classifications for AKI, an acronym of risk, injury, failure, loss of kidney function and end-stage kidney disease (RIFLE) 20 and the Acute Kidney Injury Network classification, 21 in a group of patients who had undergone myeloablative HCT, and we found that AKI was frequent after HCT and increased short-and long-term mortality. RIFLE is a newly developed classification for acute renal failure that defines three grades of severity-risk (class R), injury (class I) and failure (class F) and two outcome classes (loss of kidney function and end-stage kidney disease).…”

Section: Introductionmentioning

confidence: 99%

Contemporary analysis of the influence of acute kidney injury after reduced intensity conditioning haematopoietic cell transplantation on long-term survival

Lopes

Gonçalves

Jorge

et al. 2008

Bone Marrow Transplant

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We evaluated retrospectively the incidence of acute kidney injury (AKI), defined by risk, injury, failure, loss and end-stage kidney disease (RIFLE) and its influence on long-term survival, in 82 patients aged 18-60 years who underwent a reduced intensity conditioning (RIC) haematopoietic cell transplantation (HCT). Patients (53.6%) developed AKI after HCT: 25% were on risk, 45.5% on injury and 29.5% on failure. In all, 64 patients survived after 100 days of post transplant and were available for long-term survival analysis. At follow-up, 43.7% of patients died. A 5-year overall survival of AKI patients was 41.6% as compared with 67.1% for those who did not develop AKI (P ¼ 0.028), and decreased according to AKI severity (risk, 55.6%; injury plus failure, 33.3%; P ¼ 0.045). After adjusting for age, history of cardiovascular disease, high-risk disease and chronic GVHD, AKI predicted 5-year overall mortality (AKI: adjusted hazards ratio (AHR), 2.36, 95% CI: 1.03-5.37; P ¼ 0.041). Moreover, moderate and severe AKI (injury plus failure) was also associated with an increased 5-year overall mortality (injury plus failure: AHR, 1.64, 95% CI: 1.06-2.54; P ¼ 0.024). According to RIFLE, 53.6% of patients had AKI after RIC HCT. Such patients have poor longterm survival, particularly in moderate or severe AKI.

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Section: Introductionmentioning

confidence: 99%

Contemporary analysis of the influence of acute kidney injury after reduced intensity conditioning haematopoietic cell transplantation on long-term survival

Lopes

Gonçalves

Jorge

et al. 2008

Bone Marrow Transplant

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“…In nonmyeloablative allogeneic HCT, which employs a less toxic conditioning regimen and has fewer complications, the incidence of AKI is lower (29%-40.4%) (48,50,51). Myeloablative autologous HCT has the lowest incidence of AKI (22%) (52,53), a difference that can be attributed to the lack of graft versus host disease (GVHD), the absence of calcineurin inhibitors, and more rapid engraftment in this population. Most cases of AKI occur within the first 100 days after HCT, with an earlier onset in myeloablative (7-40 days) compared with nonmyeloablative regimens (22-60 days) (14).…”

Section: Aki After Hctmentioning

confidence: 99%

Onco-Nephrology

Lam

Humphreys

2012

Clinical Journal of the American Society of Nephrology

106

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SummaryAKI is common in patients with cancer, and it causes interruptions in therapy and increased hospital length of stay, cost, and mortality. Although cancer patients are susceptible to all of the usual causes of AKI in patients without cancer, there are a number of AKI syndromes that occur more frequently or are unique to this patient population. AKI also confers substantially increased risk of short-term death, and the ability to reverse AKI portends a better outcome in some cancers, such as multiple myeloma. Several trends in oncology, including increased survival, better supportive care, older patients who have received multiple chemotherapy regimens, and new therapeutic options, are driving an increase in the numbers of cancer patients who develop AKI. As a result, nephrologists should be increasingly familiar with the diagnosis, management, and treatment of AKI in this setting. Here, we summarize recent data on epidemiology of AKI in cancer patients, describe the most common AKI syndromes in this population, and highlight emerging areas in the growing field of onconephrology.

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“…Renal function was assessed by serum creatinine concentration and estimated GFR calculated by the modified diet in renal disease equation (GFR [mL/min per 1.73 m 2 ] ϭ 186 * P Cr Ϫ1.154 *age Ϫ0.203 * 1.212 if black, * 0.742 if female) (14). These parameters were measured on days Ϫ7, 0, 7, 14, 21, 28, 60, 90, 180, and 270 and at the end of 1 yr. ARF was classified on the basis of serum creatinine concentration and estimated GFR, similar to previous studies on autologous and myeloablative allogeneic HCT (3,6,7). The classification of ARF into four grades is described in Table 2.…”

Section: Nonmyeloablative Proceduresmentioning

confidence: 99%

Acute Renal Failure after Nonmyeloablative Hematopoietic Cell Transplantation

Parikh

Sandmaier

Storb

et al. 2004

Journal of the American Society of Nephrology

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Abstract. Acute renal failure (ARF) is a common life-threatening complication after myeloablative allogeneic hematopoietic cell transplantation (HCT). Nonmyeloablative HCT aims to eradicate the malignancy with graft-versus-tumor effect, rather than with high doses of chemoradiotherapy. It may be anticipated that a lower risk of ARF exists in nonmyeloablative HCT as a result of the milder preconditioning regimen. However, the patients who receive the nonmyeloablative HCT are older individuals who are not eligible for the more toxic allogeneic myeloablative procedure. The goal of this study was to evaluate ARF in a large group of patients who received nonmyeloablative HCT. This cohort study enrolled patients who were undergoing nonmyeloablative HCT at four major centers from 1998 to 2001. Conditioning therapy involved total body irradiation 2 Gy Ϯ fludarabine 30 mg/m 2 . Posttransplantation immunosuppression consisted of cyclosporine or tacrolimus and mycophenolate mofetil. ARF was classified into four grades, similar to previous studies in the literature. Collectively, 253 patients were recruited into this study. ARF (Ͼ50% decrease in GFR) occurred in 40.4% of patients over a 3-mo period, with 4.4% of patients requiring dialysis. The overall mortality in the study population was 34% at 1 yr. The mortality increased with worsening grade of ARF. The combined need for dialysis and artificial ventilation was associated with a mortality exceeding 80%. Although the number of patients who develop ARF is significant, the risk of developing ARF that requires dialysis after nonmyeloablative HCT is infrequent despite the older age of the patients. The data are also suggestive that ARF may contribute to mortality after nonmyeloablative HCT.Allogeneic hematopoietic cell transplantation (HCT) is the only potentially curative therapy for a variety of malignant and immunologic hematologic diseases. Myeloablative (conventional) allogeneic HCT involves the use of high-dose chemotherapy and radiotherapy conditioning regimens to eradicate the underlying disease, and the allograft serves to rescue the patient from pancytopenia induced by the treatment. One of the major limitations of this approach is the high degree of acute toxicity associated with the myeloablative conditioning regimens. This toxicity has restricted the use of myeloablative allogeneic HCT to younger, healthier patients (1,2). However, the majority of patients who present with hematologic malignancies that might be cured with myeloablative allogeneic HCT are older than the typically recommended upper age limit for this procedure of 50 to 55 yr.Despite advances in supportive care, transplant-related morbidity and mortality remain a significant obstacle to achieving maximal benefits that can be obtained from HCT. Transplantrelated organ dysfunction is a major contributor to transplantrelated complications. Specifically among these, acute renal failure (ARF) occurs frequently after both autologous and conventional allogeneic HCT. It has been demonstrated that ARF is a ...

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Renal function in high dose chemotherapy and autologous hematopoietic cell support treatment for breast cancer

Cited by 67 publications

References 13 publications

Contemporary analysis of the influence of acute kidney injury after reduced intensity conditioning haematopoietic cell transplantation on long-term survival

Contemporary analysis of the influence of acute kidney injury after reduced intensity conditioning haematopoietic cell transplantation on long-term survival

Onco-Nephrology

Acute Renal Failure after Nonmyeloablative Hematopoietic Cell Transplantation

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