Administration and pharmacokinetics of high-dose cyclophosphamide with hemodialysis support for allogeneic bone marrow transplantation in acute leukemia and end-stage renal disease

We report a patient with pre-existing end-stage renal disease (ESRD) who un derwent successful matched related donor allogeneic bone marrow transplanta tion for AML in second complete remission (CR2) using conditioning with hig h-dose cyclophosphamide (CY, 60 mg/kg/day x 2) and TBI (165 cGy twice daily x 4 days). The timing of hemodialysis after high-dose CY was extrapolated from available data on the pharmacokinetics of high-dose CY and hemodialysi s clearance of conventional dose CY and its metabolites. Pharmacokinetic an alyses indicated that the elimination of high-dose CY and its alkylating me tabolites is impaired in ESRD but is cleared with hemodialysis. The patient 's early post-transplant course was uncomplicated, and WBC and platelet eng raftment occurred by day +22, Bone marrow examination on day +25 showed tri lineage engraftment with no AML; cytogenetics showed 100% donor karyotype, The patient remains in remission with 100% donor karyotype at 3 years post transplant. Clinical results indicate that the administration of high-dose CY is feasible with hemodialysis support for patients with ESRD.