RENAL-FUNCTION IN HIGH-DOSE CHEMOTHERAPY AND AUTOLOGOUS HEMATOPOIETIC-CELL SUPPORT TREATMENT FOR BREAST-CANCER

Autologous and allogeneic bone marrow grafting both require cytoreduct ive therapy but only the allogeneic procedure requires immunosuppressi ve agents. Allogeneic bone marrow transplantation has been reported to be associated with a high incidence of both renal failure and veno-oc clusive disease (VOD) of the liver, the combination of which is associ ated with a high morbidity and mortality. There is less known about th e frequency and severity of these complications in patients undergoing autologous bone marrow transplantation. In the present study renal, h epatic and other complications were examined in 232 patients with Stag es II/III and IV breast cancer who were treated with high-dose chemoth erapy and autologous hematopoietic cell support with tither marrow or peripheral blood progenitor cells. The post-treatment severity of the renal dysfunction was classified as follows: Grade 0, normal renal fun ction [< 25% decrement in glomerular filtration rate (GFR)]; Grade 1, mild renal dysfunction (> 25% decrement in GFR but < a twofold increas e in serum creatinine): Grade 2, > twofold rise in serum creatinine bu t no need for dialysis; Grade 3. > than twofold rise In serum creatini ne and need for dialysis. There were 102 patients (44%) who were class ified as Grade 0 and 81 patient (35%) who were classified as Grade 1 r enal dysfunction. Severe renal dysfunction (Grades 2 and 3) was observ ed in 49 of the 232 patients (21%). This severe renal dysfunction of 2 1% compares with a previously reported 53% incidence of severe renal d ysfunction fur allogeneic bone marrow transplantation. Similarly, the frequency of hepatic VOD was less (4.7% or II of 232 patients) in this autologous bone marrow transplant study as compared to a reported inc idence of hepatic VOD ranging from 22 to 53% in large series of alloge neic bone marrow transplant patients. The severe renal dysfunction (Gr ades ? and 3) in the present autologous hematopoietic cell support stu dy correlated most significantly with sepsis liver and pulmonary dysfu nction. The major fall in GFR occurred during chemotherapy but before hematopoietic cell support, thus primarily incriminating the cytoreduc tive therapy rather than the hematopoietic cell support. The only sign ificant effect of different chemotherapy protocols was, at four weeks, the Taxol-treated group had a significantly lower creatinine clearanc e as compared to the BCNU treated group.