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Hemolytic-uremic syndrome following bone marrow transplantation in adults
for hematologic malignancies
SN Rabinowe, RJ Soiffer, NJ Tarbell, D Neuberg, AS Freedman, J Seifter, KW Blake, JG Gribben, KC Anderson and T Takvorian
Division of Tumor Immunology, Dana-Farber Cancer Institute, Boston, MA
02115.
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.
Volume 77,
Issue 8,
pp. 1837-1844,
04/15/1991
Copyright © 1991 by The American Society of Hematology
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