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The need for ‘onco-nephrology’ is increasing in hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 51, pages 767–768 (2016)Cite this article

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Hematopoietic stem cell transplantation (SCT) is a breakthrough curative treatment method for hematopoietic malignancy, and it has improved the vital prognosis and quality of life of patients. SCT was initiated in the late 1950s in the United States. The therapeutic outcomes of SCT markedly improved with the progression of treatment techniques and development of therapeutic drugs, with which the number of SCT applications has been increasing yearly. In the 2003 report, SCT was performed in about 50 000 adults per year worldwide.1 However, SCT patients are exposed to a large amount of highly cytotoxic antitumor drugs, irradiation and immunosuppressors, and they have to overcome serious adverse events and complications, such as organ disorders and infections, associated with these. Among the various organ disorders, acute kidney injury (AKI) is one of the most important complications determining the vital prognosis of patients.2, 3 The survival rate of patients treated with SCT markedly decreases early, within 6 months after transplantation, and then slowly decreases thereafter, reaching a plateau at about 5 years after transplantation, according to the newest data of the Japanese Data Center for Hematologic Cell Transplantation (http://www.jdchct.jdchct.or.jp/data/slide/2013). Physicians specialized in the kidney who are familiar with the perioperative period of SCT know that the development of AKI is involved in this high mortality in the early phase.2, 4

In this issue of Bone Marrow Transplantation, Lopes et al.5 reported a useful and concise review of the definition, diagnosis, incidence, and cause and prognosis associated with AKI following SCT based on the latest knowledge. According to this, making an early diagnosis of AKI and assessing the prognosis after SCT are limited even though new AKI classifications (RIFLE (2004), AKIN (2007) and KDIGO (2012) criteria) are used. To increase the ability to diagnose AKI after SCT, the measurement of new blood or urinary biomarkers, such as NGAL and L-FABP, is necessary.6, 7 The frequency, onset time and cause of AKI after SCT vary among cases and are complex depending on whether stem cells are allogeneic or autologous and whether the preconditioning procedure is myeloablative or non-myeloablative. Therefore, cooperation by physicians familiar with the treatment of hematopoietic malignancy and SCT is essential to diagnose and treat AKI.

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  1. Division of Nephrology, Department of Medicine, Cancer Center, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    M Ando

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Ando, M. The need for ‘onco-nephrology’ is increasing in hematopoietic stem cell transplantation. Bone Marrow Transplant 51, 767–768 (2016). https://doi.org/10.1038/bmt.2016.68

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