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Hemolytic uremic syndrome after bone marrow transplantation: clinical characteristics and outcome in children.

Abstract
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 for 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 (beta = .86; P = .04) and recipient cytomegalovirus seronegativity (beta = .93; P = .035) remained significant risk factors for the development of HUS.
AuthorsGregory A Hale, Laura C Bowman, Richard J Rochester, Eli Benaim, Helen E Heslop, Robert A Krance, Edwin M Horwitz, John M Cunningham, Xin Tong, Deo Kumar Srivastava, Rupert Handgretinger, Deborah P Jones
JournalBiology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 11 Issue 11 Pg. 912-20 (Nov 2005) ISSN: 1083-8791 [Print] United States
PMID16275594 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
Chemical References
  • Antilymphocyte Serum
Topics
  • Adolescent
  • Adult
  • Age Factors
  • Antilymphocyte Serum (adverse effects)
  • Bone Marrow Transplantation (adverse effects, methods)
  • Child
  • Child, Preschool
  • Cytomegalovirus
  • Graft vs Host Disease (prevention & control)
  • Hemolytic-Uremic Syndrome (etiology)
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Multivariate Analysis
  • Retrospective Studies
  • Risk Factors
  • Transplantation Conditioning (methods)

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