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The effect of post-transplant spironolactone on daily potassium requirements in patients undergoing autologous stem cell transplantation

Bone Marrow Transplantation volume 30, pages 703–704 (2002)Cite this article

Excessive potassium (K+) loss is frequently seen post-transplant following platinum containing high-dose chemotherapy (HDC) regimens such as STAMP-I (cyclophosphamide + carmustine + cisplatin), STAMP-V (cyclophosphamide + thiotepa + carboplatin), ICE (ifosfamide + carboplatin + etoposide) and TMCb (thiotepa + melphalan + carboplatin).1,2,3 Nephrotoxic antibiotics which are commonly used in the post-transplant period may also cause hypokalemia. In general, the etiology of post-transplant hypokalemia is multi-factorial. Manifestations of hypokalemia seldom occur unless the plasma K+ is << 3 mEq/l. Profound K+ depletion is associated with an increased risk of cardiac arrhythmias and also rhabdomyolysis. Smooth-muscle function might also be affected and might manifest as paralytic ileus.4 The main reasons for profound hypokalemia after HDC are renal and gastro-intestinal K+ loss due to nephrotoxicity from platinum or antibiotics and diarrhea associated with gastro-intestinal (GI) mucositis, due to alkylating agents such as thiotepa, melphalan and cyclophosphamide. Therefore, close follow-up of K+ levels is crucial for the first 2–3 weeks after transplantation. Daily K+ requirements in this setting may reach as much as 150–200 mEq/l/day. Whole day K+ replacement can be a time-consuming process and must be carried out with care. We therefore attempted to investigate the effect of spironolactone (100 mg tablet, twice daily), which is a potent aldosterone antagonist, on K+ loss following HDC. We hypothesized that administration of spironolacone during the post-transplant period may counterbalance the renal K+ loss by antagonizing aldosterone, thus decreasing K+ requirements.

Between 1999 and 2001, 40 consecutive patients meeting the eligibility criteria, with hematologic malignancies and solid tumors, were entered into a study evaluating the effect of spironolactone on daily potassium requirements following the TMCb conditioning regimen which causes excessive potassium loss. Patient characteristics are listed in Table 1. Oral and written informed consent for PBSC collection and transplantation was obtained from all patients or their guardians. All patients received thiotepa 250 mg/m2/day (on days −9 and −8), melphalan 50 mg/m2/day (on days −7 and −6) and carboplatin 400 mg/m2/day (on days −5, −4 and −3) (TMCb regimen).3 Patients rested on days −2 and −1 and PBSCs were infused on day 0.

Table 1 Patient characteristics (n = 40)
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Authors and Affiliations

  1. Ankara Numune Education and Research Hospital, Bone Marrow Transplantation Unit, Ankara, Turkey

    T Demirer, M Ayli, N Ustael, T Ustun, A Oymak, O Ozdel & O Muftuoglu

  2. Ankara University Medical School, Dept of Hematology/Oncology, Ankara, Turkey

    T Demirer

  3. Ankara Oncology Hospital, Ankara, Turkey

    M Dagli & T Fen

  4. Gazi University Medical School, Dept of Hematology and Medical Oncology, Gazi, Turkey

    R Haznedar

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  1. T Demirer
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Demirer, T., Ayli, M., Dagli, M. et al. The effect of post-transplant spironolactone on daily potassium requirements in patients undergoing autologous stem cell transplantation. Bone Marrow Transplant 30, 703–704 (2002). https://doi.org/10.1038/sj.bmt.1703728

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