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Abstract: SA-PO041

AKI in Patients With Lymphoma Submitted to Autologous Hematopoietic Stem Cell Transplant: Incidence, Risk Factors, and Prognostic Impact, A Cohort Analysis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Branco, Carolina, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal
  • Rodrigues, Natacha, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal
  • Costa, Claudia, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal
  • Marques, Filipe, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal
  • Vasconcelos, Pedro De, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal
  • Martins, Carlos Manuel Varela, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal
  • Lopes, Jose António, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Lisboa, Portugal
Background

Studies on AKI in Hematopoietic Stem Cell Transplant(HSCT) consider heterogeneous definitions for AKI include a miscellaneous of hematologic diagnoses in their cohorts. We aimed to evaluate incidence, risk factors and prognostic impact on relapse and mortality of AKI occurring in the first 100 days post-HSCT in patients with lymphomas submitted to autologous HSCT considering KDIGO classification.

Methods

Single-center retrospective cohort study including patients with lymphomas admitted for autologous HSCT between 2005 and 2015. AKI classified by KDIGO classification with daily values of creatinine and 6-hour urinary output(UO) until hospital discharge, and weekly evaluations until 100 days post-HSCT. Survival analysis methods considering death as competing risk were used to evaluate AKI cumulative incidence, risk factors and impact on relapse. Cox regression was used for AKI impact on 3-year mortality.

Results

115 patients were included, 51.3% male, 91.3% Caucasian, age 50.2(33.9-59.5), BMI 25.3(21.8-35.9), HCT-CI<2 in 84.4% of patients and mean eGFR 107.5ml/min(94.3-124.6).Hematologic diagnosis: 63.5% B-cell lymphomas, 32.2% Hodgkin lymphomas, 4.4% T-cell lymphomas. 19.3% submitted to radiotherapy in the past, number of chemotherapy cycles 9(7-10).Conditioning regimen:94.8% BEAM and 5.2% TEAM. Cumulative incidence of AKI: 62.8% 30 days post-HSCT and 63.7% 100 days post-HSCT.First diagnosis criteria: creatinine in 54.8%, UO in 41.1% and both in 4.1%. AKI highest stage: 1 in 57.5%, 2 in 17.8% and 3 in 24.7%.In multivariable model for AKI, variables independently associated with higher incidence were: nephrotoxic drugs (HR:2.87,95%CI:1.07-7.65;p=0.035), mucositis (HR:1.95,95%CI:1.16-3.29;p=0.012) and shock (HR:2.63,95%CI:1.19-5.85;p=0.017).In survival analysis, moderate to severe AKI (stage≥2) was independently associated with mortality (HR:2.04,95%CI:1.06-3.94; p=0.033).No independent association was found between AKI and relapse.

Conclusion

AKI affects almost 2/3 of patients with lymphomas submitted to autologous HSCT. Nephrotoxic drugs, mucositis and shock are important independent AKI risk factors. More than 1/3 of AKI episodes are moderate to severe and these are associated to higher 3-year mortality.