End-stage renal disease after high-dose carboplatinum in preparation of autologous stem cell transplantation Stem cell transplantation (SCT) is employed increasingly in the treatment of malignant and non-malignant pediatric diseases. Myeloablative consolidation chemotherapy followed by autolo- gous SCT is an effective method to dose-escalate therapy in patients with chemotherapy-respon- sive tumors and has been used in the treatment of high-risk pediatric solid tumors, including the Ewing’s Sarcoma Family Tumors (1). Although treatment-related morbidity and mortality have decreased, there remains the risk of significant neurological, gastro-intestinal, pulmonary, hep- atic, cardiac and renal toxicity (2). Acute and chronic renal failure are known complications of bone marrow transplantation that may be observed in as many as 30% of patients (3, 4). In adults undergoing hematopoietic SCT, both reversible acute renal failure and mild chronic renal insufficiency have been associated with carboplatinum therapy (5). However, acute renal failure with rapid progression to end-stage renal disease (ESRD) is an exceedingly rare complica- tion of carboplatinum therapy and has never been reported before in children. We now report the first such case in a child with metastatic Ewing’s sarcoma. The impact of this patient’s antecedent therapy is correlated with previous similar reports of adult patients and specific recommendations to avert this com- plication are discussed. Case report A 13-year-old girl was diagnosed with Ewing’s sarcoma at the age of 11 yr, when she presented with a 14 cm · 13 cm · 11 cm mass on the anterior chest underlying the left breast. A biopsy of the mass demonstrated a small round cell tumor; histochemical stains showed strong membrane positivity for CD 99 and scattered positivity for vimentin, consistent with an Ewing’s Sarcoma. The tumor was negative for desmin, human muscle actin, CD 45, chromogr- anin-A, synaptophysin and AE1/AE3. A chest computed axial tomographic examination dem- onstrated metastatic disease in the right lung. Her bone marrow biopsy and total body bone scan were both negative for metastatic disease. The patient was treated with the combination of Butani L, West DC, Taylor DS. End-stage renal disease after high-dose carboplatinum in preparation of autologous stem cell transplantation. PediatrTransplantation2003:7:408–412. Ó 2003BlackwellMunksgaard Abstract: Stem cell transplantation is one therapy employed in the management of children with high-risk solid tumors. However, this therapy is not without risk, having been associated with multiple end- organ toxicities. Both acute renal failure and chronic renal insufficiency have been reported in marrow transplant recipients, primarily in the context of the use of calcineurin inhibitors and radiation therapy. This report reviews our experience in managing an adolescent with meta- static Ewing’s sarcoma who developed rapid progression to end-stage renal disease following a pretransplant conditioning regimen with high- dose carboplatinum. She had not received radiation or prior cisplati- num therapy. The possible reasons for the patient’s highly unusual course and recommendations on ways to prevent this complication are discussed. Lavjay Butani, Daniel C. West and Douglas S. Taylor Sections of Pediatric Nephrology and Pediatric Hematology-Oncology, Department of Pediatrics, University of California, Davis Medical Center Key words: bone marrow transplantation – carboplatinum – hemodialysis – ifosfamide – nephrotoxicity – renal failure Lavjay Butani, MD, Section of Pediatric Nephrology, University of California, Davis Medical Center, 2516 Stockton Boulevard, Sacramento, CA 95817, USA Tel.: +1 916 734 8118 Fax: +1 916 734 0629 E-mail: lavjay.butani@ucdmc.ucdavis.edu Accepted for publication 7 February 2003 Abbreviations: AUC, area under the time-concentration curve; ESRD, end-stage renal disease; GFR, glomerular filtration rate; PD, peritoneal dialysis; SCT, stem cell transplantation. Pediatr Transplantation 2003: 7: 408–412 Printed in UK. All rights reserved Copyright Ó 2003 Blackwell Munksgaard Pediatric Transplantation 408