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Syndrome of Inappropriate Antidiuretic Hormone Secretion Complicated with Stem Cell Transplantation

Issue: Vol.8, No.4 - October 2009

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  1. Dr Ryoji Kobayashi
    M.D, PhD
    Department of Pediatrics, Sapporo Hokuyu Hospital

Hyponatremia is a common electrolyte disorders in hospitalized patients. However, reports about hyponatremia complicated with stem cell transplantation (SCT) were very rare. As single center analysis, syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) after stem cell transplantation were reported. SIADH were observed 13.2% of 197 patients after stem cell transplantation. Risk factors for SIADH were younger in age, transplantation from HLA mismatched or unrelated donor, cord blood transplantation, and GVHD prophylaxis with methyl prednisolone. Multivariate analysis showed transplantation from alternative donor was independent of other factors for SIADH. Patients with SIADH had significantly higher probability of overall survival (66.4% versus 50.8%) and event free survival (68.8% versus 43.3%) compared with no SIADH. The median onset of SIADH following cord blood transplantation (CBT) and bone marrow transplantation (BMT) / peripheral blood stem cell transplantation (PBSCT) was 19.5 and 46 days after SCT, respectively, and the median numbers of WBC were 1.1 and 3.3 x 109 /l, respectively. Furthermore, severe symptoms such as seizures, somnolence, and rigidity of limbs were observed only in patients with CBSCT (8/16 versus 0/10). These differences were statistically significant (P<0.01). SIADH is common complication with SCT, especially in patients transplanted from alternative donor. Although the precise basis for SIADH following SCT remains still unknown, the different features of SIADH observed following CBSCT and BMT/PBSCT suggest that the mechanisms responsible for SIADH are different.

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