Long-term results of selective renal shielding in patients undergoing total body irradiation in preparation for bone marrow transplantation. Bone Marrow Transplant 1997 Dec;20(12):1069-74
Date
02/18/1998Pubmed ID
9466280DOI
10.1038/sj.bmt.1701022Scopus ID
2-s2.0-0031437525 (requires institutional sign-in at Scopus site) 100 CitationsAbstract
The purpose of this study was to evaluate the effect of partial renal shielding used in conjunction with total body irradiation (TBI) on the incidence of bone marrow transplantation nephropathy (BMT Np) seen as a late sequelae after transplantation. Of 402 patients who have undergone bone marrow transplantation (BMT) at the Medical College of Wisconsin (MCW) 157 were greater than 18 years of age, received 14 Gy TBI and survived at least 100 days post-transplant. The incidence of BMT nephropathy was evaluated in these patients by dose to the kidneys. In the 72 patients who received 14 Gy TBI with no renal shielding, the actuarial risk of developing BMT Np at 2 1/2 years (30 months) post-BMT was 29 +/- 7%. Sixty-eight patients received 14 Gy TBI with partial renal shielding of 15% (renal dose = 11.9 Gy), the actuarial risk of developing BMT Np was 14 +/- 5% at 2 1/2 years. Seventeen patients received 14 Gy TBI with renal shielding of 30% (renal dose = 9.8 Gy); none of this group have developed BMT Np despite a median follow-up of over 2 1/2 years (985 days). The trend of decreasing BMT Np with increasing shielding is statistically significant (P = 0.012). Prognostic factors such as age, type of transplant and good-risk vs poor-risk disease status were evaluated and were similar in each cohort of patients described above. We conclude that given the statistically significant benefit seen here in the reduced incidence of BMT Np by the use of selective renal shielding, this should be seriously considered for all patients who receive TBI, but especially for patients whose renal doses exceed 10 Gy.
Author List
Lawton CA, Cohen EP, Murray KJ, Derus SW, Casper JT, Drobyski WR, Horowitz MM, Moulder JEAuthors
William R. Drobyski MD Professor in the Medicine department at Medical College of WisconsinMary M. Horowitz MD, MS Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Actuarial AnalysisAdult
Anemia, Aplastic
Bone Marrow Transplantation
Female
Follow-Up Studies
Hematologic Neoplasms
Humans
Incidence
Kidney
Kidney Diseases
Kidney Failure, Chronic
Male
Middle Aged
Primary Myelofibrosis
Prognosis
Proportional Hazards Models
Radiation Dosage
Radiation Injuries
Radiation Protection
Risk Factors
Transplantation Conditioning
Whole-Body Irradiation
