Renale Spättoxizität im Kindesalter nach fraktionierter Ganzkörperbestrahlung (TBI) vor allogener Stammzelltransplantation (SCT)

Purpose: To retrospectively assess the incidence and time course of renal dysfunction in children (<= 16 years) following total-body irradiation (TBI) before allogeneic stem cell transplantation (SCT). Patients and Methods: Between 1986 and 2003, 92 children (median age, 11 years; range, 3-16 years) underwent TBI before allogeneic SCT. 43 of them had a minimum follow-up of 12 months (median, 51 months; range, 12-186 months) and were included into this analysis. Conditioning regimen included chemotherapy and fractionated TBI with 12 Gy (n = 26) or 11.1 Gy (n = 17). In one patient, renal dose was limited to 10 Gy by customized renal shielding due to known nephropathy prior to SCT. Renal dysfunction was defined as an increase of serum creatinine > 1.25 times the upper limit of age-dependent normal. Results: Twelve children (28%) experienced an episode of renal dysfunction after a median of 2 months (range, 1-10 months) following SCT. In all but one patient renal dysfunction was transient and resolved after a median of 8 months (range, 3-16 months). One single patient developed persistent renal dysfunction with onset at 10 months after SCT. None of these patients required dialysis. The actuarial 3-year freedom from persistent renal toxicity for children surviving > 12 months after SCT was 97.3%. Conclusion: The incidence of persistent renal dysfunction after fractionated TBI with total doses <= 12 Gy was very low in this analysis.