Long-term kidney complications in childhood leukemia survivors: a study from the Childhood and Adolescent Leukaemia (LEA) project.

Abstract

Acute leukaemias represent the 1st cause of cancer in children. Their prognosis has improved significantly due to remarkable advances in therapeutic management, despite the risk of long-term consequences, especially for patients who underwent allogenic hematopoietic stem cell transplantation (aHSCT). Through the Leukaemia in Children and Adolescents (LEA) long-term follow-up cohort, we conducted a French national multicentre prospective study on the occurrence and risk factors of chronic kidney disease (CKD), differentiating glomerular and tubular dysfunctions, corresponding to the NephroLEA project. Among the 1676 patients included, the median [interquartile range] age at evaluation was 15.8 [11.3-20.5] years, with a median follow-up of 9.2 [5.8-13.9] years. aHSCT was performed on 343 (20.6%) patients, half of whom have undergone the procedure after achieving 2nd or greater remission. A higher percentage of children among transplanted patients had diastolic and systolic blood pressure above 95th, with 13.7% vs 5.2% (P =3x10-3) and 15% vs 6.5% (P = 9x10-2), respectively. A total of 187 patients (11.1%) had a mild CKD (i.e., eGFR between 75 and 90 mL/min/1.73 m2), while 3% (n=50) exhibited mild to severe CKD (eGFR < 75 mL/min/1.73 m2). Notably, no patient reached kidney failure. Twenty-one patients (1.3%) had decreased GFR associated with tubular impairment. The principal risk factors for developing CKD were aHSCT and leukaemia relapse. In conclusion, CKD represents a long-term risk for patients who relapsed and/or underwent aHSCT. These patients could benefit from nephroprotection advice to further improve their long-term outcomes, which is becoming a public health issue.