Late nephrotoxicity of modified program NHL-BFM-90 in adult patients poor prognosis of diffuse large B-cell lymphoma

To evaluate late nephrotoxicity of modified program NHL-BFM-90 (mNHL-BFM-90) in adult patients with poor-prognosis of diffuse large B-cell lymphoma (DLBCL). The data of laboratory tests of blood and urine of 40 patients (20 men and 20 women) with DLBCL treated during 2002--2009 years with modified NHL-BFM-90 protocol were analyzed. Comparison group included 19 patients (8 men and 11 women) treated with CHOP or R-CHOP. The median observation period after chemotherapy was 6 years. Laboratory tests of blood and urine were performed before chemotherapy and in 5 years after treatment. Results. Chronic kidney diseases were found in 32 (80%) patients treated with mNHL-BFM-90 vs in 12 (63%) treated with CHOP/R-CHOP. Only 2 (5%) patients had decreased creatinine clearance. The frequency of nephrotoxic complications was significantly higher in patients treated with mNHL-BFM-90 than with CHOP/R-CHOP. Treatment with high-dose chemotherapy was complicated by acute renal failure in 10 (25%) patients, 2 (20%) patients required hemodialysis in comparison with patients treated with standard chemotherapy (p= 0.01). However, in the long term observations there were no significant differences in the nephrotoxic complications between two groups.

1. Magomedova A.U., Kravchenko S.K., Kremenetskaya A.M., Zvonkov E.A., Baryakh E.A., Mangasarova Ya.K., Vorobiev A.I. Nine-year experience in the treatment of patients with diffuse large B-cell lymphosarcoma. Therapeutic archive. Russian Journal (Terapevticheskiy arkhiv). 2011; 7: 5–10. (in Russian)

2. Zvonkov E.E., Kremenetskaya A.M., Kravchenko S.K., Makhinya V.A. The effectiveness of conservative treatment of gastric lymphosarcoma. Therapeutic archive. Russian Journal(Terapevticheskiy arkhiv). 2008; 7: 18–26. (in Russian)

3. Kravchenko S.K., Magomedova A.U., Zamyatina V.A., Margolin O.V. Highdose therapy of generalized(without bone marrow involvement) diffuse large B-cell lymphoma in elderly patients. Hematology and Transfusiology. Russian journal (Gematologiya i Transfusiologiya). 2008; 3: 6–9. (in Russian)

4. Magomedova A.U., Kravchenko S.K., Kremenetskaya A.M., Zvonkov E.E., Baryakh E.A., Lorie Yu.Yu., Ovchinina N.G. The modified NHLBFM-90 program in the treatment of patients with diffuse large B-cell lymphosarcoma. Therapeutic archive. Russian Journal (Terapevticheskiy arkhiv). 2006; 10: 44–7. (in Russian)

5. Sun X.F., Zhen Z.J., Xia Y., Lin S.X., Zhu J., Wang J., et al. Outcome of children and adolescents with Burkitt lymphoma and diffuse large B cell lymphoma treated with a modified NHL-BFM-90 protocol. Zhonghua Xue Ye Xue Za Zhi. 2013; 34(12): 1032–7. doi:10.3760/cma.j.issn.0253-2727.2013.12.008.

6. Samochatova E.V., Maschan A.A., Shelikhova L.N., Myakova N.V., Belogurova M.B., Khlebnikova O.P. Therapy of advanced-stage mature B-cell lymphoma and leukemia in children and adolescents with rituximab and reduced intensity induction chemotherapy (B-NHL-2004M Protocol): the results of a multicenter study. J. Pediatr. Hematol. Oncol. 2014; 36(5): 395–401. doi:10.1097/MPH.0b013e31829d4900.

7. Sahni V., Choudhury D., Ahmed Z. Chemotherapy-associated renal dysfunction. Nat. Rev. Nephrol. 2009; 5(8): 450–62. doi: 10.1038/nrneph.2009.97.

8. Perazella M.A., Moeckel G.W. Nephrotoxicity from chemotherapeutic agents: clinical manifestations, pathobiology, and prevention/therapy. Semin. Nephrol. 2010; 30(6): 570–81. doi:10.1016/j.semnephrol.2010.09.005.

9. Kintzel P.E. Anticancer drug-induced kidney disorders. Drug. Saf. 2001; 24(1): 19–38.

10. Choi M., Sun C.L., Kurian S., Carter A., Francisco L., Forman S.J., Bhatia S. Incidence and predictors of delayed chronic kidney disease in longterm survivors of hematopoietic cell transplantation. Cancer. 2008; 113(7): 1580–7. doi:10.1002/cncr.23773.

11. Elyasi S., Khalili H., Dashti-Khavidaki S., Mohammadpour A. Vancomycin-induced nephrotoxicity: mechanism, incidence, risk factors and special populations. A literature review. Eur. J. Clin. Pharmacol. 2012; 68(9): 1243–55. doi:10.1007/s00228-012-1259-9.

12. Ellis M.J., Parikh C.R., Inrig J.K., Kanbay M., Patel U.D. Chronic kidney disease after hematopoietic cell transplantation: a systematic review. Am. J. Transplant. 2008; 8(11): 2378–90. doi:10.1111/j.1600-6143.2008.02408.x.

13. Hingorani S., Guthrie K.A., Schoch G., Weiss N.S., McDonald G.B. Chronic kidney disease in long-term survivors of hematopoietic cell transplant. Bone Marrow Transplant. 2007; 39(4): 223–9.

14. Karimzadeh I., Farsaei S., Khalili H., Dashti-Khavidaki S. Are salt loading and prolonging infusion period effective in prevention of amphotericin B-induced nephrotoxicity? Expert Opin. Drug Saf. 2012; 11(6): 969–83. doi: 10.1517/14740338.2012.721775.

15. Strizhevskaya A.M., Golovnya E.G., Dzampaev A.Z., Baykova V.N. Biochemical criteria of toxicity of therapy with high doses of methotrexate in children with osteosarcoma. Advances in Molecular Oncology. Russian Journal (Uspekhi Molekulyarnoy Onkologii). 2015; 2(1): 082–9. doi:10.17650/2313-805X.2015.2.1.082-089. (in Russian)

16. Ulrich C.M., Yasui Y., Storb R., Schubert M.M., Wagner J.L., Bigler J. Pharmacogenetics of methotrexate: toxicity among marrow transplantation patients varies with the methylenetetrahydrofolate reductase C677T polymorphism. Blood. 2001; 98(1): 231–4.

17. Ongaro A., De Mattei M., Della Porta M.G., Rigolin G.M., Ambrosio C., Di Raimondo F. Gene polymorphisms in folate metabolizing enzymes in adult acute lymphoblastic leukemia: effects on methotrexate-related toxicity and survival. Haematologica. 2009; 94(10): 1391–8. doi: 10.3324/haematol.2009.008326.

18. Pimenova M.A., Sokolov A.N., Biryukova L.S., Ustinova E.N., Shaforostova I.I., Donskova I.A., et al. Extremely high concentration of methotrexate in the blood serum, followed by acute renal failure in a patient with acute lymphoblastic leukemia after high-dose consolidation. Therapeutic archive. Russian Journal (Terapevticheskiy arkhiv). 2011; 7: 58–61. (in Russian)

19. Naughton C.A. Drug-induced nephrotoxicity. Am. Fam. Physician. 2008; 78(6): 743–50.

20. Kolygin B.A., Kuleva S.A. The effects of anticancer therapy in children. St. Peterburg: Gippokrat; 2011. (in Russian)

21. Sarzhevskiy V.O., Melnichenko V.Ya., Tyurin V.L. Renal toxicity of highdose chemotherapy with autologous bone marrow transplantation (peripheral stem cells) in hemoblastoses.Bulletin of Pirogov’s National MedicoSurgical Center. Russian Journal (Vestnik Natsionalnogo mediko-khirurgicheskogo tsentra im. N.I. Pirogova). 2013; 2: 66–71. (in Russian)

22. Kaya Z., Gursel T., Bakkaloglu S.A., Kocak U., Atasever T., Oktar S.O. Evaluation of renal function in Turkish children receiving BFM-95 therapy for acute lymphoblastic leukemia. Pediatr. Hematol. Oncol. 2007; 24(4): 257–67.

23. Grönroos M.H., Jahnukainen T., Möttönen M., Perkkiö M., Irjala K., Salmi T.T. Long-term follow-up of renal function after high-dose methotrexate treatment in children. Pediatr. Blood Cancer. 2008; 51(4): 535–9. doi: 10.1002/pbc.21650.

24. Oberlin O., Fawaz O., Rey A., Niaudet P., Ridola V., Orbach D., et al. Long-term evaluation of ifosfamide-related nephrotoxicity in children. J. Clin. Oncol. 2009; 27(32): 5350–5. doi: 10.1200/JCO.2008.17.5257.

25. Dekkers I.A., Blijdorp K., Cransberg K., Pluijm S.M., Pieters R., Neggers S.J., van den Heuvel-Eibrink M.M. Long-term nephrotoxicity in adult survivors of childhood cancer. Clin. J. Am. Soc. Nephrol. 2013; 8(6): 922–9. doi: 10.2215/CJN.09980912.

26. Lukina A.E., Baryakh E.A., Kravchenko S.K., Biryukova L.S., Gemdzhyan E.G., Magomedova A.U., et al. Features of renal damage in Burkitt’s lymphoma. Therapeutic archive. Russian Journal (Terapevticheskiy arkhiv). 2012; 7: 31–4. (in Russian)

27. Smirnov A.V. National guidelines. Chronic kidney disease: the basic principles of screening, diagnosis, prevention and treatment approaches. Nefrology. Russian Journal (Nefrologiya). 2012; 1: 89–115. (in Russian)

28. Common Terminology Criteria for Adverse Events (CTCAE)v 4.0. Publish Date: May 28, 2009. Available at: http://www.evs.nci.nih.gov/CTCAE/CTCAE_4.03_2010-06-14