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Bone Marrow Transplantation Nephropathy after an Intensified Conditioning Regimen with Radioimmunotherapy and Allogeneic Stem Cell Transplantation

¹ Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany; ² Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany; ³ Department of Transfusion Medicine, University Hospital Ulm, Ulm, Germany; ⁴ Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany; and ⁵ Department of Radiation Therapy, University Hospital Ulm, Ulm, Germany

Correspondence: For correspondence or reprints contact: Donald Bunjes, MD, Universitätsklinik Ulm, Department of Internal Medicine III, Robert-Koch-Strasse 8, 89081 Ulm, Germany.E-mail: donald.bunjes{at}medizin.uni-ulm.de

Intensification of the conditioning regimen with a radioactively labeled anti-CD66 antibody is feasible before allogeneic stem cell transplantation. The use of radioimmunotherapy may deliver a significant dose of radiation to the kidneys. We therefore studied the incidence and clinical picture of bone marrow transplantation (BMT) nephropathy in our patients receiving radioimmunotherapy before allogeneic stem cell transplantation. Methods: This study was a clinical trial of 114 consecutive patients who received conditioning with a radiolabeled anti-CD66 antibody—¹⁸⁸Re (n = 93) or ⁹⁰Y (n = 21)—between 1998 and 2003. Results: Although BMT nephropathy has developed in none of the patients in the [⁹⁰Y]anti-CD66 group, 6 of 93 patients receiving [¹⁸⁸Re]anti-CD66 presented with signs of BMT nephropathy at a median of 11.5 mo after stem cell transplantation. The absorbed renal dose was significantly lower in the ⁹⁰Y group (4 vs. 7 Gy, P < 0.0001). Of the patients receiving [¹⁸⁸Re]anti-CD66 who are alive, BMT nephropathy developed in 19% (6/32). Five of 6 patients with BMT nephropathy received total-body irradiation. The patients presented with elevated serum creatinine, proteinuria, anemia, hypertension, and signs of microangiopathy. All 6 patients in whom BMT nephropathy has developed are alive at a median follow-up of 58 mo after stem cell transplantation, and 1 patient has entered a dialysis program. Conclusion: BMT nephropathy appears to be a significant problem after allogeneic stem cell transplantation with intensified conditioning using the ¹⁸⁸Re-labeled anti-CD66 applied in this study, particularly when combined with total-body irradiation.

Key Words: radioimmunotherapy • BMT nephropathy • ¹⁸⁸Re • ⁹⁰Y

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