Renal dysfunction because of radiation exposure was recognized decades ago. The incidence declined when more effective chemotherapeutic agents became available. However, there appears to be a resurgence with the advent of total body irradiation used prior to hematopoietic stem cell transplantation. Several chemotherapeutic drugs used prior to total body irradiation have some ionizing radiation potentiating effects. Chronic kidney disease that occurs after hematopoietic stem cell transplantation is known to occur due to nephrotoxicity from medications, graft-versus-host disease, and the currently under-recognized radiation exposure. The clinical features vary depending on the dose of radiation and the volume of single or bilateral kidneys exposed. The usual symptoms of fatigue, edema, anemia, malignant hypertension, azotemia, and shortness of breath appear in 6–12 months of exposure. Since this is an under-recognized entity, there are no large controlled trials to guide therapy. This review highlights some of the experimental data that have shown some promising results for treatment. There is need for further studies on the current incidence and prevalence and clinical trials to guide treatment, based on the experimental data available.
Single-Center 20-Year Experience of Matched Allogenic Hematopoietic Stem Cell Transplantation in Adults with T-ALL/Lbl Using Cyclophosphamide and Total Body Irradiation
