This study reports the data of 32 children with poor-prognosis solid tumors who had 78 PBSC harvests on Fenwall CS-3000plus after mobilization mainly by different treatment protocol chemotherapy regimens followed by G- or GM-CSF (92% of patients) or by G-/GM-CSF alone (8%). Timing of procedure was predicted by studying the blood count. When the white blood cell and platelet count reached a median of 8.1 (0.9-37.3) and 95 (16-338) x 10(9)/L, respectively, the median number of 2.7 (0.005-16.8) x 10(6) CD34+/kg with 1.5 (0.005-11.6) x 10(6) CD34+/kg for 1 blood volume processed was obtained per procedure. In the group of 13 patients with low body weight (median 14 [10-20] kg) 32 leukophereses were performed. The extracorporal line was primed with donor red blood cells in the patients with the weight below 15 kg. No difference was observed in CD34+ content in harvests whether GM-CSF was begun on day +1 or on day +3 after chemotherapy.

The significance of enzymuria in assessing the nephrotoxicity of cisplatin in a total dose of 100 mg/m 2 or iphosphamide in a total dose of 9 g/m 2 for children with solid malignant tumors (10 and 9 patients, respectively) was studied. Chemotherapy caused stable hyperenzymuria consisting in a significant increase in N-acetyl-lS-D-hexosaminidase, 7-glutamyltransferase, and alanine aminopeptidase activities in the urine during chelnotherapy in comparison with the initial values. The levels of enzyme excretion with the urine were higher in patients treated with iphosphamide than in those treated with cisplatin. The increase in serum creatinine and urea concentrations vs. the age-specific noru~ was obsen,ed in only 2 out of 9 children treated with iphosphamide. These results permit considering enzymuria as the most sensitive method for the diagnosis of nephrotoxicity. Key Words: chemotherapy; nephrotoxicity; urine enzymesThe therapeutic effect of antitumor drugs is often associated with toxic effects on various organs and systems. Nephrotoxicity characteristic of the platinum preparations, iphosphamide, and other cytostatics is a complication limiting the drug dose. Biochemical parameters routinely used for the diagnosis of toxic involvement of the kidneys, primarily nitrogen-containing serum compounds urea and creatinine, are not vein informative. Measurements of the urinary enzymes have been recently used for the diagnosis of renal involvement caused by toxic effects of antitumor, antibacterial, and other drugs [1,6,8,10]. Biochemical analysis of urine for early detection of nephrotoxicity of antitumor therapy is particularly ilnpoJtant in pediatric oncology, since the proposed method is noninvasive. The aim of this study was to assess the significance of biochemical parametel~ of blood serum and urine for timely diagnosis of nephrotoxicity in children with solid tumors receiving chelnotherapy. MATERIALS AND METHODSThe nephrotoxicity of chemotherapy protocols including iphosphalnide and cisplatin has been assessed by biochemical analysis of the blood and urine in :19 children (10 boys and 9 girls) aged 5-16 yeal~ before, during, and after chemotherapy. The children were followedup from 2 weeks to 3 months, during this period they were administered 1-3 5-day courses at 3-4-week hltervals. Nine children with nephroblastoma relapses (n=3), nephroblastoma (n=2), rhabdonayosarcoma (n=3), and disseminated Ewing's sarcoma (n=l) were treated by iphosphalnide-based protocols including iphosphamide in a total dose of 9 g/m 2 per course, vepeside (500 rag/m2), and carboplatin (450 1rig/m2). Ten children with osteogenic sarcoma (n=4)

We retrospectively compared the effects of two time points of G-CSF (Filgrastim) introduction for PBSC mobilization in 45 children with different malignancies. Seventeen patients received the first G-CSF dose on day 2 or 3 following chemotherapy (group 1). Twenty-eight patients received a "flexible" G-CSF injection schedule when the G-GSF was started at the time of the first platelet count rise during post-chemotherapy recovery phase (group 2). Leukapheresis was performed when WBC recovery reached >2.0 × 10 9 /l or if the peripheral blood CD34 + cell level was >0.01 × 10 9 /l. A median of 2 (1-4) leukapheresis procedures was performed in both groups to yield a median of 4.2 and 6.1 × 10 6 CD34 + cells/kg in groups 1 and 2, respectively, which was generally sufficient for auto-transplantation. The proportion of patients with a failure of PBSC collection was similar and G-CSF consumption estimated through the total cycle dose was 2.3 times less in group 2 without increasing infectious risks. The short-term hematological recovery and the early post-transplant course were similar in the two groups. Delayed introduction of G-CSF after chemotherapy allowed PBSC harvest equivalent to that obtained after early G-CSF introduction. This approach could be an interesting alternative in PBSC mobilization but should be assessed by a prospective controlled study. Am. J. Hematol. 73:225-229, 2003.

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