Impact of drug therapy, radiation dose, and dose rate on renal toxicity following bone marrow transplantation
Impact of drug therapy, radiation dose, and dose rate on renal toxicity following bone marrow transplantation
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DOI：
10.1016/j.ijrobp.2007.12.009
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发表时间：
2008-08-01
影响因子：
7
通讯作者：
Wong, Jeffrey Y. C.
中科院分区：
文献类型：
--
作者：
Cheng, Jonathan C.;Schultheiss, Timothy E.;Wong, Jeffrey Y. C.
目的：证明辐射剂量反应，并确定影响全身照射 (TBI) 后晚期肾毒性发生率的剂量学和化疗因素。方法和材料：对报告晚期肾毒性的文章以及肾脏剂量、分割、剂量率、化疗方案和潜在的肾毒性药物进行了全面的回顾性审查。在最终分析中，纳入了 12 篇文章（n = 1,108 名患者），其中包括 24 种不同的 TBI/化疗调理方案。治疗方案分为三个亚组：成人（18 岁）、儿童（年龄 < 18 岁）和混合人群（成人和儿童）。进行多变量逻辑回归以确定与晚期肾脏并发症显着相关的剂量学和化疗因素。结果：对每个人群亚组进行个体分析。对于纯粹的成年人群来说，唯一显着的变量是总剂量。对于混合人群，重要变量包括总剂量、剂量率和氟达拉滨的使用。对于儿科人群，只有环孢素或替尼泊苷的使用才有意义；没有注意到剂量反应。由于儿童缺乏剂量反应，因此生成了逻辑模型，排除了儿童群体。该模型产生了以下重要变量：总剂量、剂量率和分数。结论：确定了 TBI 后肾损伤的剂量反应。分次治疗和低剂量率是向接受骨髓移植的患者提供 TBI 时需要考虑的因素。药物治疗对肾功能也有重大影响，并且可以改变剂量反应功能。 (c) 2008 爱思唯尔公司。
Purpose: To demonstrate a radiation dose response and to determine the dosimetric and chemotherapeutic factors that influence the incidence of late renal toxicity following total body irradiation (TBI).Methods and Materials: A comprehensive retrospective review was performed of articles reporting late renal toxicity, along with renal dose, fractionation, dose rate, chemotherapy regimens, and potential nephrotoxic agents. In the final analysis, 12 articles (n = 1,108 patients), consisting of 24 distinct TBI/chemotherapy conditioning regimens were included. Regimens were divided into three subgroups: adults (age 18 years), children (age < 18 years), and mixed population (both adults and children). Multivariate logistic regression was performed to identify dosimetric and chemotherapeutic factors significantly associated with late renal complications.Results: Individual analysis was performed on each population subgroup. For the purely adult population, the only significant variable was total dose. For the mixed population, the significant variables included total dose, dose rate, and the use of fludarabine. For the pediatric population, only the use of cyclosporin or teniposide was significant; no dose response was noted. A logistic model was generated with the exclusion of the pediatric population because of its lack of dose response. This model yielded the following significant variables: total dose, dose rate, and number of fractions.Conclusion: A dose response for renal damage after TBI was identified. Fractionation and low dose rates are factors to consider when delivering TBI to patients undergoing bone marrow transplantation. Drug therapy also has a major impact on kidney function and can modify the dose-response function. (c) 2008 Elsevier Inc.