Unexpected acute renal injury after high-dose etoposide phosphate and total body irradiation in children undergoing hematopoietic stem cell transplantation

Pediatr Blood Cancer. 2017 Dec;64(12). doi: 10.1002/pbc.26669. Epub 2017 Jul 11.


High-dose etoposide phosphate, a water-soluble prodrug of etoposide, may be used after total body irradiation (TBI) in pediatric allogeneic bone marrow transplantation for lymphoblastic leukemia. In a retrospective study of 21 children treated at the Nancy University Hospital (2000-2014), we identified unprecedentedly an unexpectedly high incidence (57%) of acute renal injury following etoposide phosphate infusion. Patients who developed renal function impairment experienced more severe mucositis but had outcomes similar to those who did not. No risk factors were identified. We speculate that the etoposide phosphate diluent, dextran 40, may have been the causative agent in these post-TBI renal toxicity cases.

Keywords: ALL; chemotherapy; general hematology/oncology; pharmacology; renal complications after BMT; transplantation.

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Adolescent
  • Antineoplastic Agents / adverse effects*
  • Child
  • Child, Preschool
  • Etoposide / adverse effects
  • Etoposide / analogs & derivatives*
  • Female
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Male
  • Organophosphorus Compounds / adverse effects*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / therapy*
  • Retrospective Studies
  • Whole-Body Irradiation*


  • Antineoplastic Agents
  • Organophosphorus Compounds
  • etoposide phosphate
  • Etoposide