TY - JOUR
T1 - Hemolytic uremic syndrome after bone marrow transplantation
T2 - Clinical characteristics and outcome in children
AU - Hale, Gregory A.
AU - Bowman, Laura C.
AU - Rochester, Richard J.
AU - Benaim, Eli
AU - Heslop, Helen E.
AU - Krance, Robert A.
AU - Horwitz, Edwin M.
AU - Cunningham, John M.
AU - Tong, Xin
AU - Srivastava, Deo Kumar
AU - Handgretinger, Rupert
AU - Jones, Deborah P.
N1 - Funding Information:
The authors thank Frances Curran and Nancy Wright for data management; Margaret Aymond, Patricia Johnson, and Cynthia Walker for data collection; Sara Williams and Jill Owens for manuscript preparation; and Janet Davies for editorial assistance. This work was supported in part by National Institutes of Health Cancer Center Support grant no. P 30CA 21765 and the American Lebanese Syrian Associated Charities.
PY - 2005/11
Y1 - 2005/11
N2 - Hemolytic uremic syndrome (HUS) is an uncommon but potentially life-threatening complication of hematopoietic stem cell transplantation. We retrospectively studied the medical records of 293 children who underwent allogeneic bone marrow transplantation at St. Jude Children's Research Hospital between 1992 and 1999 to describe the clinical course of and to identify risk factors forn transplant-associated HUS. Conditioning regimens included cyclophosphamide, cytarabine, and total body irradiation for patients with hematologic malignancies (n = 244); patients with nonmalignant diseases (n = 49) received disease-specific regimens. Grafts from unrelated or mismatched related donors were depleted of T lymphocytes, whereas matched sibling grafts were unmanipulated. All patients received cyclosporine as prophylaxis for graft-versus-host disease. Recipients of grafts from matched siblings also received pentoxifylline or short-course methotrexate. HUS developed in 28 (9.6%) patients at a median of 171 days after transplantation. We identified older donor age (P = .029), use of antithymocyte globulin in the conditioning regimen (P = .008), and recipient CMV seronegativity (P = .011) as being associated with an increased risk of HUS. With a multiple regression analysis, the use of antithymocyte globulin (β = .86; P = .04) and recipient cytomegalovirus seronegativity (β = .93; P = .035) remained significant risk factors for the development of HUS.
AB - Hemolytic uremic syndrome (HUS) is an uncommon but potentially life-threatening complication of hematopoietic stem cell transplantation. We retrospectively studied the medical records of 293 children who underwent allogeneic bone marrow transplantation at St. Jude Children's Research Hospital between 1992 and 1999 to describe the clinical course of and to identify risk factors forn transplant-associated HUS. Conditioning regimens included cyclophosphamide, cytarabine, and total body irradiation for patients with hematologic malignancies (n = 244); patients with nonmalignant diseases (n = 49) received disease-specific regimens. Grafts from unrelated or mismatched related donors were depleted of T lymphocytes, whereas matched sibling grafts were unmanipulated. All patients received cyclosporine as prophylaxis for graft-versus-host disease. Recipients of grafts from matched siblings also received pentoxifylline or short-course methotrexate. HUS developed in 28 (9.6%) patients at a median of 171 days after transplantation. We identified older donor age (P = .029), use of antithymocyte globulin in the conditioning regimen (P = .008), and recipient CMV seronegativity (P = .011) as being associated with an increased risk of HUS. With a multiple regression analysis, the use of antithymocyte globulin (β = .86; P = .04) and recipient cytomegalovirus seronegativity (β = .93; P = .035) remained significant risk factors for the development of HUS.
KW - Bone marrow transplantation
KW - Hemolysis
KW - Hemolytic uremic syndrome
KW - Microangiopathy
KW - Pediatrics
KW - Renal failure
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UR - http://www.scopus.com/inward/citedby.url?scp=27844507105&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2005.07.012
DO - 10.1016/j.bbmt.2005.07.012
M3 - Article
C2 - 16275594
AN - SCOPUS:27844507105
VL - 11
SP - 912
EP - 920
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
SN - 1083-8791
IS - 11
ER -