melphalan and Hyperammonemia

We report a patient with multiple myeloma who suffered from hyperammonemia after a second stem cell autograft. This syndrome is not well known but is associated with a high mortality rate. Considering the possibility of this diagnosis in patients developing confusion and neurological degradation with respiratory alkalosis after intensive chemotherapy, could allow earlier treatment and perhaps improved survival. Possible mechanisms and potential therapies are discussed. With rapid recognition and treatment of the syndrome, the patient fully recovered. One and a half years later, she is still alive and well, on interferon for persisting myeloma.

Topics: Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Dexamethasone; Doxorubicin; Female; Hematopoietic Stem Cell Transplantation; Humans; Hyperammonemia; Melphalan; Middle Aged; Multiple Myeloma; Prednisolone; Vincristine