Hemolytic-Uremic Syndrome Following Bone Marrow Transplantation in Adults for Hematologic Malignancies

• Published in: Blood Vol. 77; no. 8; pp. 1837 - 1844
• Main Authors: Rabinowe, Susan N., Soiffer, Robert J., Tarbell, Nancy J., Neuberg, Donna, Freedman, Arnold S., Seifter, Julian, Blake, Kelly W., Gribben, John G., Anderson, Kenneth C., Takvorian, Tak, Ritz, Jerome, Nadler, Lee M.
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 15.04.1991; The Americain Society of Hematology
• Subjects: Adult; Biological and medical sciences; Bone Marrow Transplantation - adverse effects; Bone Marrow Transplantation - physiology; Cyclophosphamide - therapeutic use; Hematocrit; Hematologic and hematopoietic diseases; Hemolytic-Uremic Syndrome - etiology; Humans; Kidney Function Tests; Leukemia - surgery; Lymphoma, Non-Hodgkin - surgery; Medical sciences; Middle Aged; Transplantation, Autologous; Transplantation, Homologous; Whole-Body Irradiation; Bone marrow; Malignant hemopathy; Transplantation; Hemolytic uremic syndrome; Surgery
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V77.8.1837.1837

One hundred and sixty eight adult patients with B-cell non-Hodgkin's lymphoma (NHL) and other hematologic malignancies who underwent autologous or allogeneic bone marrow transplantation (BMT) were investigated for the subsequent development of hemolytic-uremic syndrome (HUS). All patients were conditioned with cyclophosphamide and total body irradiation. When examined at 3-month intervals for the first year post-BMT, all patients had uniform measurements of hematocrit (Hct) and serum creatinine. Sixteen patients who initially exhibited Hct and creatinine values that were normal range for the BMT populations developed a sudden decrease in Hct and increase in creatinine between 3 and 11 months post-BMT and fulfilled the clinical and laboratory criteria for HUS. None of these patients had known active cytomegalovirus infection, graft-versus-host disease, or cyclosporine administration. The degree of decrease in Hct and creatinine elevation ranged from solely laboratory abnormalities to a clinically significant syndrome. Twelve of the 16 patients developed acute clinical complications of congestive heart failure, hypertension (HTN), or peripheral edema. Twelve patients required red blood cell support, whereas only four patients required platelet transfusions. Both hemolytic anemia and thrombocytopenia have resolved in virtually all cases. At a mean follow up of 18 months postdiagnosis, creatinine elevations have persisted along with HTN. All patients have survived without life-threatening long-term sequelae. With the increasing use of BMT as a curative modality for patients with hematologic malignancies, it becomes important to prospectively monitor patients for the development of HUS and its potential long-term impact on renal function.