Acute kidney injury during leukocyte engraftment after autologous stem cell transplantation in patients with light-chain amyloidosis

Maria Irazabal Mira, Alfonso Eirin, Morie Gertz, Angela Dispenzieri, Shaji K Kumar, Francis K. Buadi, Martha Lacy, Suzanne R. Hayman, David M Dingli, William Hogan, Dennis A. Gastineau, Siobhan V. Glavey, Hatem Amer, Nelson Leung

Research output: Contribution to journalArticle

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Abstract

Engraftment syndrome (ES) is a complication of hematopoietic stem cell transplantation characterized by fever, rash, and non-cardiogenic pulmonary edema. Acute kidney injury (AKI) has been recognized but is considered a minor criterion in one and excluded another definition of ES. We have noted a high incidence of AKI in patients with immunoglobulin light-chain amyloidosis (AL) undergoing autologous stem cell transplant (ASCT) around the time of leukocyte engraftment. This study was conducted to further investigate the relationship between AKI and ES. Data were collected from 377 AL patients who underwent ASCT from 7/1997 to 10/2009. Patients who experienced an elevation of serum creatinine >0.5 mg/dL within 4 days of leukocyte engraftment and anyone who presented with signs associated with ES regardless of renal manifestations were included. Forty-one patients met criteria. Twelve were excluded for positive cultures (10), acute interstitial nephritis (1), and acute cellular rejection (1). In addition to AKI (93.1%), patients also exhibit fever (82.7%), hypotension (51.7%), rash (48.2%), edema (93.1%), diarrhea (69.0%), conjunctival hemorrhage (31.0%), pulmonary edema (31.0%), pulmonary hemorrhage (13.8%), and transient encephalopathy (17.2%). Patient with pulmonary involvement were more likely to require dialysis but was not statistically significant. AKI was very common during leukocyte engraftment in AL patients. While infectious etiology accounted for some of the AKI, most appeared to be associated with ES. After infection is ruled out, ES should be considered in the differential diagnosis when evaluating AKI in this population.

Original languageEnglish (US)
Pages (from-to)51-54
Number of pages4
JournalAmerican Journal of Hematology
Volume87
Issue number1
DOIs
StatePublished - Jan 2012

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Stem Cell Transplantation
Amyloidosis
Acute Kidney Injury
Leukocytes
Light
Pulmonary Edema
Exanthema
Fever
Stem Cells
Hemorrhage
Transplants
Immunoglobulin Light Chains
Interstitial Nephritis
Lung
Hematopoietic Stem Cell Transplantation
Brain Diseases
Hypotension
Dialysis
Diarrhea
Edema

ASJC Scopus subject areas

  • Hematology

Cite this

Acute kidney injury during leukocyte engraftment after autologous stem cell transplantation in patients with light-chain amyloidosis. / Irazabal Mira, Maria; Eirin, Alfonso; Gertz, Morie; Dispenzieri, Angela; Kumar, Shaji K; Buadi, Francis K.; Lacy, Martha; Hayman, Suzanne R.; Dingli, David M; Hogan, William; Gastineau, Dennis A.; Glavey, Siobhan V.; Amer, Hatem; Leung, Nelson.

In: American Journal of Hematology, Vol. 87, No. 1, 01.2012, p. 51-54.

Research output: Contribution to journalArticle

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abstract = "Engraftment syndrome (ES) is a complication of hematopoietic stem cell transplantation characterized by fever, rash, and non-cardiogenic pulmonary edema. Acute kidney injury (AKI) has been recognized but is considered a minor criterion in one and excluded another definition of ES. We have noted a high incidence of AKI in patients with immunoglobulin light-chain amyloidosis (AL) undergoing autologous stem cell transplant (ASCT) around the time of leukocyte engraftment. This study was conducted to further investigate the relationship between AKI and ES. Data were collected from 377 AL patients who underwent ASCT from 7/1997 to 10/2009. Patients who experienced an elevation of serum creatinine >0.5 mg/dL within 4 days of leukocyte engraftment and anyone who presented with signs associated with ES regardless of renal manifestations were included. Forty-one patients met criteria. Twelve were excluded for positive cultures (10), acute interstitial nephritis (1), and acute cellular rejection (1). In addition to AKI (93.1{\%}), patients also exhibit fever (82.7{\%}), hypotension (51.7{\%}), rash (48.2{\%}), edema (93.1{\%}), diarrhea (69.0{\%}), conjunctival hemorrhage (31.0{\%}), pulmonary edema (31.0{\%}), pulmonary hemorrhage (13.8{\%}), and transient encephalopathy (17.2{\%}). Patient with pulmonary involvement were more likely to require dialysis but was not statistically significant. AKI was very common during leukocyte engraftment in AL patients. While infectious etiology accounted for some of the AKI, most appeared to be associated with ES. After infection is ruled out, ES should be considered in the differential diagnosis when evaluating AKI in this population.",
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