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Mitigation of late renal and pulmonary injury after hematopoietic stem cell transplantation.

AbstractPURPOSE:
To update the results of a clinical trial that assessed whether the angiotensin-converting enzyme inhibitor captopril was effective in mitigating chronic renal failure and pulmonary-related mortality in subjects undergoing total body irradiation (TBI) in preparation for hematopoietic stem cell transplantation (HSCT).
METHODS AND MATERIALS:
Updated records of the 55 subjects who were enrolled in this randomized controlled trial were analyzed. Twenty-eight patients received captopril, and 27 patients received placebo. Definitions of TBI-HSCT-related chronic renal failure (and relapse) were the same as those in the 2007 analysis. Pulmonary-related mortality was based on clinical or autopsy findings of pulmonary failure or infection as the primary cause of death. Follow-up data for overall and pulmonary-related mortality were supplemented by use of the National Death Index.
RESULTS:
The risk of TBI-HSCT-related chronic renal failure was lower in the captopril group (11% at 4 years) than in the placebo group (17% at 4 years), but this was not statistically significant (p > 0.2). Analysis of mortality was greatly extended by use of the National Death Index, and no patients were lost to follow-up for reasons other than death prior to 67 months. Patient survival was higher in the captopril group than in the placebo group, but this was not statistically significant (p > 0.2). The improvement in survival was influenced more by a decrease in pulmonary mortality (11% risk at 4 years in the captopril group vs. 26% in the placebo group, p = 0.15) than by a decrease in chronic renal failure. There was no adverse effect on relapse risk (p = 0.4).
CONCLUSIONS:
Captopril therapy produces no detectable adverse effects when given after TBI. Captopril therapy reduces overall and pulmonary-related mortality after radiation-based HSCT, and there is a trend toward mitigation of chronic renal failure.
AuthorsEric P Cohen, Manpreet Bedi, Amy A Irving, Elizabeth Jacobs, Rade Tomic, John Klein, Colleen A Lawton, John E Moulder
JournalInternational journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 83 Issue 1 Pg. 292-6 (May 1 2012) ISSN: 1879-355X [Electronic] United States
PMID22104363 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
CopyrightPublished by Elsevier Inc.
Chemical References
  • Angiotensin-Converting Enzyme Inhibitors
  • Radiation-Protective Agents
  • Captopril
Topics
  • Adult
  • Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
  • Captopril (therapeutic use)
  • Child
  • Female
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Kidney Failure, Chronic (etiology, mortality, prevention & control)
  • Lung Injury (etiology, mortality, prevention & control)
  • Male
  • Prospective Studies
  • Radiation Injuries (prevention & control)
  • Radiation-Protective Agents (therapeutic use)
  • Transplantation Conditioning (adverse effects, methods)
  • Whole-Body Irradiation (adverse effects, methods)

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