Renal toxicity of ifosfamide in pilot regimens of the intergroup rhabdomyosarcoma study for patients with gross residual tumor

Beverly Raney, Lisa G. Ensign, John Foreman, Fareed Khan, William Newton, Jorge Ortega, Abdelsalam Ragab, Moody Wharam, Eugene Wiener, Harold Maurer, Richard Andrassy, William Crist, Sarah Donaldson, Christopher Fryer, Edmund Gehan, Denman Hammond, Daniel Hays, Ruth Heyn, Walter Lawrence, Thorn LobeFrederick Ruymann, Melvin Tefft, Timothy Triche, Teresa Vietti, Bruce Webber

Research output: Contribution to journalArticle

Abstract

Purpose The purpose of this review is to characterize the nephrotoxicity noted in newly diagnosed patients under 21 years of age after treatment with ifosfamide-containing chemotherapy regimens and local irradiation for localized gross residual rhabdomyosarcoma or undifferentiated sarcoma.: Patients and Methods From 1987 to 1991, 194 previously untreated patients received vincristine and ifosfamide plus dactinomycin or etoposide for 1–2 years. Ifosfamide was given at 1.8 g/m2/day for 5 days with sodium mercaptoethane sulfonate, or 9 g/m2of ifosfamide per course. The three-drug regimen was repeated every 3–4 weeks.: Results Twenty-eight patients (14%) developed renal toxicity: 19 had renal tubular dysfunction (RTD) characterized by low serum phosphate (≤ 3 mg/dl) or bicarbonate (≤ 20 mEq/L) levels, five had decreased glomerular function (DGF), and four had both RTD and DGF. When nine or more courses of ifosfamide (≥72 g/m2) were given, children 2) were given (p = 0.03). A matched case-control comparison showed that renal abnormalities at diagnosis, chiefly hydronephrosis, also increased the risk of renal tubular injury by ifosfamide by a factor of 13 (p <0.001). Patients with DGF tended to be older than those with RTD, and all but one received > 72 g/m2of ifosfamide.: Conclusions Patients who are 72 g/m2) of ifosfamide and who have a preexisting renal abnormality have an increased risk of RTD and DGF. The renal function of patients being considered for ifosfamide treatment must be carefully monitored. Ifosfamide should be avoided in patients with renal abnormalities at diagnosis unless the potential benefit clearly exceeds the risk of further renal impairment.

Original languageEnglish (US)
Pages (from-to)286-295
Number of pages10
JournalAmerican Journal of Pediatric Hematology/Oncology
Volume16
Issue number4
StatePublished - 1994
Externally publishedYes

Fingerprint

Ifosfamide
Rhabdomyosarcoma
Residual Neoplasm
Kidney
Hydronephrosis
Dactinomycin
Vincristine
Etoposide
Bicarbonates
Sarcoma
Sodium
Phosphates
Drug Therapy

Keywords

  • Ifosfamide
  • Renal toxicity
  • Rhabdomyosarcoma in childhood

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Pediatrics, Perinatology, and Child Health

Cite this

Renal toxicity of ifosfamide in pilot regimens of the intergroup rhabdomyosarcoma study for patients with gross residual tumor. / Raney, Beverly; Ensign, Lisa G.; Foreman, John; Khan, Fareed; Newton, William; Ortega, Jorge; Ragab, Abdelsalam; Wharam, Moody; Wiener, Eugene; Maurer, Harold; Andrassy, Richard; Crist, William; Donaldson, Sarah; Fryer, Christopher; Gehan, Edmund; Hammond, Denman; Hays, Daniel; Heyn, Ruth; Lawrence, Walter; Lobe, Thorn; Ruymann, Frederick; Tefft, Melvin; Triche, Timothy; Vietti, Teresa; Webber, Bruce.

In: American Journal of Pediatric Hematology/Oncology, Vol. 16, No. 4, 1994, p. 286-295.

Research output: Contribution to journalArticle

Raney, B, Ensign, LG, Foreman, J, Khan, F, Newton, W, Ortega, J, Ragab, A, Wharam, M, Wiener, E, Maurer, H, Andrassy, R, Crist, W, Donaldson, S, Fryer, C, Gehan, E, Hammond, D, Hays, D, Heyn, R, Lawrence, W, Lobe, T, Ruymann, F, Tefft, M, Triche, T, Vietti, T & Webber, B 1994, 'Renal toxicity of ifosfamide in pilot regimens of the intergroup rhabdomyosarcoma study for patients with gross residual tumor', American Journal of Pediatric Hematology/Oncology, vol. 16, no. 4, pp. 286-295.
Raney, Beverly ; Ensign, Lisa G. ; Foreman, John ; Khan, Fareed ; Newton, William ; Ortega, Jorge ; Ragab, Abdelsalam ; Wharam, Moody ; Wiener, Eugene ; Maurer, Harold ; Andrassy, Richard ; Crist, William ; Donaldson, Sarah ; Fryer, Christopher ; Gehan, Edmund ; Hammond, Denman ; Hays, Daniel ; Heyn, Ruth ; Lawrence, Walter ; Lobe, Thorn ; Ruymann, Frederick ; Tefft, Melvin ; Triche, Timothy ; Vietti, Teresa ; Webber, Bruce. / Renal toxicity of ifosfamide in pilot regimens of the intergroup rhabdomyosarcoma study for patients with gross residual tumor. In: American Journal of Pediatric Hematology/Oncology. 1994 ; Vol. 16, No. 4. pp. 286-295.
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abstract = "Purpose The purpose of this review is to characterize the nephrotoxicity noted in newly diagnosed patients under 21 years of age after treatment with ifosfamide-containing chemotherapy regimens and local irradiation for localized gross residual rhabdomyosarcoma or undifferentiated sarcoma.: Patients and Methods From 1987 to 1991, 194 previously untreated patients received vincristine and ifosfamide plus dactinomycin or etoposide for 1–2 years. Ifosfamide was given at 1.8 g/m2/day for 5 days with sodium mercaptoethane sulfonate, or 9 g/m2of ifosfamide per course. The three-drug regimen was repeated every 3–4 weeks.: Results Twenty-eight patients (14{\%}) developed renal toxicity: 19 had renal tubular dysfunction (RTD) characterized by low serum phosphate (≤ 3 mg/dl) or bicarbonate (≤ 20 mEq/L) levels, five had decreased glomerular function (DGF), and four had both RTD and DGF. When nine or more courses of ifosfamide (≥72 g/m2) were given, children 2) were given (p = 0.03). A matched case-control comparison showed that renal abnormalities at diagnosis, chiefly hydronephrosis, also increased the risk of renal tubular injury by ifosfamide by a factor of 13 (p <0.001). Patients with DGF tended to be older than those with RTD, and all but one received > 72 g/m2of ifosfamide.: Conclusions Patients who are 72 g/m2) of ifosfamide and who have a preexisting renal abnormality have an increased risk of RTD and DGF. The renal function of patients being considered for ifosfamide treatment must be carefully monitored. Ifosfamide should be avoided in patients with renal abnormalities at diagnosis unless the potential benefit clearly exceeds the risk of further renal impairment.",
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T1 - Renal toxicity of ifosfamide in pilot regimens of the intergroup rhabdomyosarcoma study for patients with gross residual tumor

AU - Raney, Beverly

AU - Ensign, Lisa G.

AU - Foreman, John

AU - Khan, Fareed

AU - Newton, William

AU - Ortega, Jorge

AU - Ragab, Abdelsalam

AU - Wharam, Moody

AU - Wiener, Eugene

AU - Maurer, Harold

AU - Andrassy, Richard

AU - Crist, William

AU - Donaldson, Sarah

AU - Fryer, Christopher

AU - Gehan, Edmund

AU - Hammond, Denman

AU - Hays, Daniel

AU - Heyn, Ruth

AU - Lawrence, Walter

AU - Lobe, Thorn

AU - Ruymann, Frederick

AU - Tefft, Melvin

AU - Triche, Timothy

AU - Vietti, Teresa

AU - Webber, Bruce

PY - 1994

Y1 - 1994

N2 - Purpose The purpose of this review is to characterize the nephrotoxicity noted in newly diagnosed patients under 21 years of age after treatment with ifosfamide-containing chemotherapy regimens and local irradiation for localized gross residual rhabdomyosarcoma or undifferentiated sarcoma.: Patients and Methods From 1987 to 1991, 194 previously untreated patients received vincristine and ifosfamide plus dactinomycin or etoposide for 1–2 years. Ifosfamide was given at 1.8 g/m2/day for 5 days with sodium mercaptoethane sulfonate, or 9 g/m2of ifosfamide per course. The three-drug regimen was repeated every 3–4 weeks.: Results Twenty-eight patients (14%) developed renal toxicity: 19 had renal tubular dysfunction (RTD) characterized by low serum phosphate (≤ 3 mg/dl) or bicarbonate (≤ 20 mEq/L) levels, five had decreased glomerular function (DGF), and four had both RTD and DGF. When nine or more courses of ifosfamide (≥72 g/m2) were given, children 2) were given (p = 0.03). A matched case-control comparison showed that renal abnormalities at diagnosis, chiefly hydronephrosis, also increased the risk of renal tubular injury by ifosfamide by a factor of 13 (p <0.001). Patients with DGF tended to be older than those with RTD, and all but one received > 72 g/m2of ifosfamide.: Conclusions Patients who are 72 g/m2) of ifosfamide and who have a preexisting renal abnormality have an increased risk of RTD and DGF. The renal function of patients being considered for ifosfamide treatment must be carefully monitored. Ifosfamide should be avoided in patients with renal abnormalities at diagnosis unless the potential benefit clearly exceeds the risk of further renal impairment.

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KW - Rhabdomyosarcoma in childhood

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