Hyponatremia and syndrome of inappropriate antidiuretic hormone secretion complicating stem cell transplantation

Abstract

Summary:Hyponatremia is a common electrolyte disorder in hospitalized patients. Although there are a few case reports of hyponatremia following stem cell transplantation (SCT), no reports concerning the incidence are currently available. We describe the occurrence of hyponatremia and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) following SCT. In a single center analysis of 140 patients, hyponatremia and SIADH were observed in 40 and 11.4% of patients, respectively, following SCT. Risk factors for SIADH included young age, transplantation from an HLAmismatched or unrelated donor, cord blood transplantation, and graft-versus-host disease prophylaxis with methyl prednisolone. Multivariate analysis revealed that transplantation from an HLA-mismatched donor and performance of SCT in a child below 4 years of age were risk factors for SIADH. For patients who underwent SCT from an HLA-mismatched or unrelated donor, those with SIADH showed a significantly higher overall survival rate (90.9 vs 40.2%) and event-free survival rate (77.8 vs 33.8%) compared to those without SIADH. Overall, our data show that hyponatremia and SIADH are relatively common complications following SCT, especially in children below 4 years of age and after SCT from an HLA-mismatched donor.

The syndrome of inappropriate secretion of antidiuretic hormone associated with SCT: clinical differences following SCT using cord blood and BM/peripheral blood

“…3 In this study, although this conclusion was confirmed (data not shown), neurological sequelae following SCT occurred in survivors with SIADH more frequently than in those without SIADH. All patients with SIADH were promptly and appropriately treated with fluid restriction, diuretics or hypertonic saline (3% NaCl) and recovered from hyponatremia.…”

“…These results, except for age, concurred with our previous report. 3 Although we have no available data at present, IL-6 has been reported to be involved in SIADH. [12][13][14] In addition, levels of cytokines such as IL-6 and tumor necrosis factor-a are known to be high in SCT from an HLA-mismatched donor or an unrelated donor.…”

“…In our previous report, 3 severe hyponatremia of less than 125 mmol/l was a complication in 27 (19.3%) of the 140 SCT patients, and 16 (56.9%) of them were diagnosed with SIADH. Moreover, multivariate analysis revealed that alternative donor and recipient below the age of 4 years were the only independent predictors of SIADH.…”

“…Although the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) also seems to be one of these complications, there are only few case reports available on SIADH following SCT, 1,2 including our previous report. 3 Therefore, SIADH following SCT has had its importance underestimated.…”

Syndrome of Inappropriate Antidiuretic Hormone Secretion Induced by Tacrolimus Following Allogeneic Cord Blood Transplantation

“…In approximately half of these cases, hyponatremia develops due to syndrome of inappropriate antidiuretic hormone ( ADH ) secretion (SIADH) (1,2). The general causes of SIADH include central nervous system infection (3), malignancies, such as leukemia and lymphoma (4), and drugs, such as chemotherapeutics and antiepileptic agents (5).…”