Abstract
To assess impact of multi-disciplinary therapy for nephrotoxicity, including hematopoietic stem cell transplantation (HSCT), among childhood hematology and oncology survivors, we conducted retrospective longitudinal study. Thirty-eight survivors (HSCT [N=14] and non-HSCT [N=24] groups) were recruited. The 50%ile standard serum creatinine*100/serum creatinine (CrM1) was assessed before treatment (T1); upon therapy completion (T2); and 1 (T3), 3 (T4), and 5 (T5) years after therapy completion. We analyzed correlations between cumulative dose of anticancer drugs and CrM1 over time. We found that average CrM1 level decreased especially in HSCT group from T1 to T5 (HSCT: T1 112⇒T5 98, Non-HSCT: T1 133⇒T5 111). Twenty-one percent of HSCT survivors showed grade 2 or higher nephrotoxicity on T2 through T5, whereas only 4% (T4) of non-HSCT survivors showed grade 2 kidney dysfunction. Surprisingly, the CrM1 of neuroblastoma survivors in the HSCT group significantly decreased from T1 to T5 (108 to 85). Pearson's correlation analyses revealed strong correlations between CrM1 and cumulative doses of cyclophosphamide (T3 γ=−0.47, p<0.01) and cisplatin (T3 γ=−0.56, p<0.01). Multi-disciplinary therapy, including HSCT, could be a risk factor for long-term nephrotoxicity. The most severe nephrotoxicity were found in survivors with neuroblastoma who had received HSCT. Medical team should conduct risk-based follow-up for renal function for hemato-oncology survivors.
