Jan. 5, 2001 While there has been a dramatic increase in the use of bone marrow transplantation (BMT) to treat patients with cancer it has come at a high price. One of the major side effects of curing cancer patients is the high rate of acute and chronic renal failure, according to an editorial in the Jan. 4, 2000, issue of Lancet by Eric Cohen, M.D., associate professor of medicine at the Medical College of Wisconsin in Milwaukee.
Currently, five to 15 per cent of all patients undergoing bone marrow transplants develop acute kidney failure. Of the long-term BMT survivors, five to 20 percent develop chronic kidney failure. "This is a major problem," says Dr. Cohen, "and needs to be addressed by the research community."
At the Medical College, Dr. Cohen and his team are studying ways to prevent kidney damage. In animal studies they found that ace inhibitors, used to treat high blood pressure and reduce kidney injuries, were effective in preventing kidney damage. A randomized, double-blind study is being done in humans with the ace inhibitor captopril to prevent problems with chronic kidney failure. For more information or to participate in the study call Victoria Johnson at 414-805-4632.
In the last 20 years, the number of BMTs done world wide to cure cancer, jumped from a few hundred to 40,000 autologous or self-transplants, and 15,000 allogeneic or donor transplants.
The complications of kidney failure are directly related to the process and course of BMT including pre-transplantation high-dose chemotherapy and total body radiation therapy to kill off the cancer cells. The resulting weakened immune system can lead to infections and other complications resulting in kidney failure. Additionally, anti-rejection drugs used to prevent the graft vs. host disease in donor transplants can be toxic to the kidney.
Dr. Cohen points out that chronic kidney failure was recognized over ten years ago as being related to total body irradiation. He believes that genetic factors may explain why there is such a wide variability in radiation-induced tissue injury. A better understanding of this response and the ability to identify people most at risk for normal tissue-radiation injury would lead to better use of radiation therapy before BMT and other uses.
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