melphalan and Coma

Topics: Brain Diseases; Coma; Humans; Immunosuppressive Agents; Male; Melphalan; Middle Aged; Myeloablative Agonists; Paraproteinemias; Plasmapheresis; Prednisone; Scleromyxedema; Thalidomide; Treatment Outcome

We report here a 50-years old female with multiple myeloma-associated chronic renal failure who underwent high-dose chemotherapy supported by autologous hematopoietic stem cell transplantation. She developed progressive encephalopathy on day 5 progressing to coma despite hemodialysis and no obvious organ failure. She finally recovered after a single 1-liter plasma exchange. The final diagnosis was metabolic encephalopathy due to hypercytokinemia, particularly high serum TNF levels. We discuss here the pathogenesis and raise an alert for monitoring cytokine levels in patients with renal failure undergoing high-dose chemotherapy.

Topics: Brain Diseases, Metabolic; Coma; Female; Hematopoietic Stem Cell Transplantation; Humans; Melphalan; Middle Aged; Multiple Myeloma; Plasma Exchange; Renal Dialysis; Renal Insufficiency; Treatment Outcome; Tumor Necrosis Factor-alpha

High-dose melphalan (HDM) with peripheral blood stem cell transplant (PBSCT) is a common treatment for patients with multiple myeloma (MM) and more recently also with AL amyloidosis (ALA). We report two female patients with severe renal failure who underwent treatment with HDM for MM (patient 1) and ALA (patient 2). Both patients developed severe encephalopathy with generalised tonic-clonic seizures and a Glasgow Coma Scale (GCS) of 3/15. Causes for coma such as infections, metabolic disturbances, cerebral ischaemia or haemorrhage were excluded. Patient 1 died on day 25 post transplant while comatose. Patient 2 recovered from her comatose state 18 days after transplantation. To our knowledge this is the first report on a possible role of high-dose melphalan in the development of encephalopathy.

Topics: Amyloidosis; Antineoplastic Agents, Alkylating; Coma; Combined Modality Therapy; Epilepsy, Tonic-Clonic; Fatal Outcome; Female; Glasgow Coma Scale; Hematopoietic Stem Cell Transplantation; Humans; Melphalan; Middle Aged; Multiple Myeloma; Treatment Outcome