melphalan and Tumor-Lysis-Syndrome

Topics: Acute Kidney Injury; Antineoplastic Combined Chemotherapy Protocols; Carboplatin; Child; Combined Modality Therapy; Etoposide; Granulocyte Colony-Stimulating Factor; Hematopoietic Stem Cell Mobilization; Humans; Male; Melphalan; Neuroblastoma; Peripheral Blood Stem Cell Transplantation; Transplantation, Autologous; Treatment Outcome; Tumor Lysis Syndrome

The treatment of AL amyloidosis was not successful until the advent of myeloablative chemotherapy consisting of high-dose intravenous melphalan followed by autologous peripheral blood stem cell transplantation. This new treatment has achieved better survival rates and, remarkably, it has obtained complete remission. Among patients with renal involvement, achievement of a complete hematological response was associated with a 50% reduction in proteinuria and stable creatinine clearance in more than 2/3 of patients. Despite of these excellent results, this new therapy is associated with significant toxicity, including the development of acute renal failure due to white blood cell lysis syndrome. We report a 59 year-old female with a nephrotic syndrome due to primary amyloidosis successfully treated autologous stem cell transplantation who developed acute renal failure caused by white blood cell lysis syndrome. The patient required treatment with granulocytic colony stimulating factor and intermittent hemofiltration and was discharged 23 days after melphalan administration with a satisfactory renal function and white blood cell count. After one year of follow up, she maintains a good glomerular filtration rate, a proteinuria of less than, 1 g/day and normal hematological values.

Topics: Acute Kidney Injury; Amyloidosis; Antineoplastic Combined Chemotherapy Protocols; Female; Humans; Melphalan; Middle Aged; Myeloablative Agonists; Peripheral Blood Stem Cell Transplantation; Transplantation, Autologous; Tumor Lysis Syndrome

Tumour lysis syndrome (TLS) in plasma cell dyscrasias is extremely rare. TLS has been described in eight cases of multiple myeloma undergoing high-dose therapy with autologous stem cell transplant (ASCT). Recently, clinical trials of intensive chemotherapy followed by autologous or allogeneic stem cell support has been shown to offer potential benefit in AL (amyloid light-chain) amyloidosis. TLS in primary AL amyloidosis in this setting has not been previously reported. We report a case of TLS in a patient with AL amyloidosis which developed after high-dose melphalan chemotherapy supported by ASCT.

Topics: Acute Disease; Aged; Amyloidosis; Antineoplastic Agents, Alkylating; Fatal Outcome; Female; Hematopoietic Stem Cell Transplantation; Humans; Melphalan; Tumor Lysis Syndrome

We report a patient with centroblastic non-Hodgkin's MALT lymphoma of the stomach treated initially with surgery and post-operative chemotherapy and radiotherapy. First relapse was treated with high-dose BEAM chemotherapy and autologous peripheral blood stem cell transplantation (PBSCT). Second, systemic relapse was treated with high-dose BU/CY and second PBSCT. Today, the patient is in complete remission at 27+ months. The case indicates a curative potential for high-dose BU/CY chemotherapy as salvage therapy for relapsed high-grade lymphoma after BEAM and autologous PBSCT. This may have implications for the prevention as well as for the management of lymphoma relapse after high-dose chemotherapy (HDC) and autologous PBSCT.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Cisplatin; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Doxorubicin; Epirubicin; Etoposide; Granulocyte Colony-Stimulating Factor; Hematopoietic Stem Cell Transplantation; Humans; Ifosfamide; Injections, Spinal; Lymphoma, B-Cell, Marginal Zone; Male; Melphalan; Methotrexate; Prednisone; Recurrence; Remission Induction; Retreatment; Salvage Therapy; Stomach Neoplasms; Transplantation Conditioning; Tumor Lysis Syndrome; Vincristine

A new therapeutic approach was adopted for 13 consecutive patients with stage IV neuroblastoma over 1 year of age admitted to the Children's Hospital, University of Helsinki, between October 1981 and August 1985. Treatment was based on induction, with aggressive, repeated early surgery and a relatively short course of chemotherapy with cisplatinum and etoposide, and on consolidation, with 140-180 mg/m2 of melphalan followed by autologous unpurged bone marrow. Induction therapy failed in only 2 of the 13 patients. One of the two was never autografted. So a total of 12 children underwent autologous marrow transplantations, 10 in primary and 1 in secondary remission, and one with residual disease. One patient died in septicemia during postmelphalan pancytopenia, and four patients relapsed 0.3-2.9 years after transplantation. Seven of the original 13 patients (54%) are well and living in continuous remission 2.3-4.1 (median 2.8) years after diagnosis.

Topics: Antineoplastic Agents; Bone Marrow Transplantation; Child; Child, Preschool; Cisplatin; Combined Modality Therapy; Etoposide; Female; Follow-Up Studies; Humans; Infant; Male; Melphalan; Neoplasm Recurrence, Local; Neoplasm Staging; Neuroblastoma; Prognosis; Remission Induction; Retrospective Studies; Survival Rate; Transplantation, Autologous; Tumor Lysis Syndrome