Successful haematopoietic stem cell transplantation in a boy with advanced chronic kidney disease – a case report

A case of a 16-year-old male with stage III chronic kidney caused by reflux-obstructive nephropathy, later diagnosed with severe aplastic anaemia and referred for allogenic haematopoietic stem cell transplantation, is presented. The conditioning regimen prior to the procedure required cyclophosphamide, for which dosing had to be carefully adjusted in view of impaired kidney function to avoid potential complications. Therefore, an unusual approach of pre-emptive use of renal replacement therapy was chosen with no dose reduction of the conditioning regimen. The patient underwent continuous veno-venous haemodiafiltration for to 70 hours after receiving the first dose of cyclophosphamide, with no complications observed. The patient underwent successful conditioning followed by haematopoietic stem cell transplantation, and maintained stable kidney function. In conclusion, such a procedure in a patient with advanced chronic kidney disease requires an individual, patient-oriented approach, with close involvement of a nephrologist in the transplant medical team.